Posterior Cruciate Ligament Injury

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Posterior Cruciate Ligament Injury

(PCL Tear)

Definition

The posterior cruciate ligament (PCL) is a piece of connective tissue located within the knee. The PCL connects the thighbone to the shinbone. This connection keeps the shinbone from moving too far backward, and stabilizes the knee.

The PCL ligament can become strained or torn when a strong force is applied to it. This can happen during sports or other high-stress activity.

Treatment depends on the severity of the injury.

Posterior Cruciate Ligament

Causes

Injury to the PCL can be caused by a variety of events, including:

Sports injury
Motor vehicle accident
Fall on a bent knee
Strong force to the leg immediately below the kneecap
Knee dislocation

Risk Factors

The following factors increase your chance of injuring the PCL:

Playing sports
Previous knee injury, including dislocation

Symptoms

Symptoms may include:

Pain and swelling in the knee
Soreness in the area behind the knee
Weakness or instability in the knee
Difficulty walking
Pain when moving the knee

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will need to see images of your knee.

Tests may include:

X-ray
MRI

Ligament sprains are graded according to their severity:

Grade 1—Mild ligament damage.
Grade 2—Partial tearing of the ligament.
Grade 3—Complete tearing of the ligament.

Treatment

Talk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:

Acute Care

Rest

Your ligament will need time to heal. Avoid activities that place extra stress on the knee:

Do not do activities that cause pain. This includes running, jumping, and weight lifting using the legs.
Do not play sports until your doctor has said it is safe to do so.

Your doctor may recommend a knee brace to stabilize the knee, and crutches to keep extra weight off your leg.

Cold

Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.

Pain Relief Medications

To manage pain, your doctor may recommend:

Over-the-counter medication, such as aspirin, ibuprofen, or acetaminophen
Topical pain medication—creams or patches that are applied to the skin
Prescription pain relievers

Compression

Compression can help prevent more swelling. Your doctor may recommend an elastic compression bandage around your knee. Be careful not to wrap the bandage too tight.

Elevation

Elevation can also help keep swelling down. Keep your knee higher than your heart as much as possible for the first 24 hours or so. A couple of days of elevation might be recommended for severe sprains.

Recovery Steps

Heat

Use heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the ligament.

Stretching

When the acute pain is gone, start gentle stretching as recommended. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times. Stretch several times a day.

Strengthening

Begin strengthening exercises for your ligaments as recommended.

If you are diagnosed with a PCL injury, follow your doctor's instructions.

Surgery

Surgery may be needed to fully restore function of the knee. The decision to have surgery should be made after discussion with your doctor about your athletic needs, age, and associated factors.

Prevention

Most PCL injuries occur during accidents that are difficult to prevent. To reduce your chance of injuring the PCL, take these steps:

Protect your knees by doing regular strengthening exercises for your thighs.
Maintain proper technique when exercising or playing sports.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.org

American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Knee sprains and meniscal injuries. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/fractures%5Fdislocations%5Fand%5Fsprains/knee%5Fsprains%5Fand%5Fmeniscal%5Finjuries.html. Updated February 2012. Accessed May 3, 2012.

Ligament injuries to the knee. John Hopkins Medicine website. Available at. http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/orthopaedic%5Fdisorders/ligament%5Finjuries%5Fto%5Fthe%5Fknee%5F85,P00926/. Accessed May 3, 2013.

Posterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00420. Updated February 2009. Accessed May 3, 2013.

Posterior cruciate ligament (PCL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 11, 2013. Accessed May 3, 2013.

10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

Revision Information

Reviewer: Rosalyn Carson-DeWitt, MD; Brian Randall, MD
Review Date: 05/2013 -
Update Date: 05/03/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Cartersville Medical Center