Together with the other three main ligaments of the knee (the Anterior Cruciate Ligament (ACL) and the two collateral ligaments), the Posterior Cruciate Ligament (PCL) has the paramount function of providing stability to the knee joint, primarily preventing the posterior translation of the tibia on the femur and secondarily assisting in resisting varus, valgus and rotational forces. Compared to the ACL, the PCL is nearly twice as thick and strong, making it less prone to injuries. Due to its function and resilience, injuries to the PCL are typically due to high-energy impacts where an external force is applied to the tibia on a flexed knee position, such as during motor vehicular collision (classic dashboard injury), falling onto flexed knees, or during sports (e.g.: soccer, basketball, skiing, etc.) where a hyperextension mechanism (± rotation) is more commonly identified. Patients with an acutely injured PCL often report pain (typically in the posterior aspect of the knee), swelling, reduced mobility, instability and limited function. Ligament injuries are classified based on the severity of the reported damage on a 3-grade scale system. Grade I, often referred to as a sprain, is the mildest reportable injury, while grade III, characterised by a full-thickness tear, is the highest level of damage. As per every other condition, the management of these injuries depends upon the specific of the reported damage itself, however, due to its elevated intrinsic healing capacity, PCL injuries are often successfully treated non-surgically.
Non-surgical management
Conservative management of PCL injuries is typically recommended in patients with a grade I-II injury, minor to moderate laxity, no associated damages to the surrounding structures, and it is more likely to succeed in relatively acute/recent injuries. Non-surgical management typically consists of facilitating the natural healing process of the ligament by setting it in a “relaxed” position and limiting its stretch, goals that are usually accomplished with the implementation of a brace (specifically designed for PCL injuries) coupled with the use of crutches. The use of brace, crutches and the specifics of the allowed percentage of weight bearing and range of motion can strongly vary based on the implemented protocol and is usually at the discretion of the medical team.
Surgical management
In case of higher injury grades that result in significant laxity and instability, associated damages reported to the surrounding structures, or a chronically injured ligament, surgical management is the preferred path. Similarly to the ACL, PCL reconstruction is the most implemented procedure and the specifics of the surgery are always discussed in detail between the patient and the medical-surgical team. As per the conservative management, the post-surgical period is characterised by the use of a bracing protocol and the use of crutches to limit ligament tensioning. A gradual and progressive range of motion recovery is recommended and must be closely monitored by specialised medical staff to ensure the optimal biological healing process of the ligament after the procedure.
rehabilitation
Regardless of the implemented management (surgical vs non-surgical), rehabilitation should be started as soon as possible to optimise the recovery process and decrease the risk of complications. Especially with cruciate ligaments injuries, we strongly recommend patients be guided and assisted by a specialised Medical Team that can take care of the whole recovery process, from the beginning to the end. After being visited by one of our doctors, you will be prescribed the best recovery programme tailored to your condition. Your advances in the recovery journey will be guided by different tests (e.g.: isokinetic test, threshold test, movement analysis test, etc.), to ensure a safe and effective progression. Your rehabilitation will take place in different environments, and you will reduce your symptoms and recover your mobility in the gym and pool, restore your strength in our gym, enhance your movement quality in our movement analysis room and return to your activities and sports after completing the on-field rehabilitation.