Before discussing about PCL injury, it is good to know more about how stability of knee joint is affected. One of the four ligaments that is important to the stability of the knee joint is the posterior cruciate ligament. The anterior cruciate ligament (ACL) sits just in front of the Posterior Cruciate Ligament (PCL).
Symptoms of PCL Injury – Knee Injury
If you have injured your PCL you will usually experience pain in your knee that increases when you run, kneel, squat, slow down or use ramps and stairs. Tenderness and swelling usually set in within 3 hours of the injury with bruising to follow within 1-2 days. Your knee may be stable enough to walk but you may also notice a small degree of instability or it giving way during certain activities when you are not careful.
Most diagnosis point to juries to the ACL rather than to the PCL, so the ACL is much better known. In fact about 20 percent of knee ligament injuries affects the PCL but the PCL is less talked about simply because such knee injuries are often left undiagnosed.
The PCL prevents the tibia (shin bone) from sliding too far backwards. As the ACL keeps the tibia from sliding too far forward, on the other hand, the PCL helps to maintain the tibia in position below the femur (thigh bone).
Anterior Cruciate Ligament – Knee Injury ACL
Both PCL and ACL tear are quite similar with similar symptoms. Knee injury pain, swelling, and restricted motion are common with both injuries. Patients may tell you that they feel as though their knee “popped” or gave out. Knee instability is more common in the following weeks or months following after an ACL tear as compared to PCL tear.
When patients have instability after a PCL injury they usually state that they can’t “trust” their knee, or that it feels as though the knee may give out. If this complaint of instability is a problem after a PCL injury, it may be an indication that surgery is recommended.
How is PCL knee injury diagnosed?
Understanding how the injury happened provided part of the diagnosis of a PCL tear. Knowing the story of the injury (for example, the position of the leg and what happened) will help in the diagnosis. Specific maneuvers can test the function of the PCL. The posterior drawer test is however, the most reliable drawer test.
With the knee bent, your doctor will push the tibia backwards stressing the PCL. The tibia will slide too far backwards if the PCL is torn or deficient, indicating an injury to the PCL.
X-rays and MRIs are also helpful in clarifying the diagnosis and detecting any other injury in the structures of the knee. When a PCL tear is found, it is common to find other ligament injuries or cartilage damage.
PCL tears have various degree of severity from grade I through grade III. The grade is determined by the extent of laxity measured during your examination. In general, grading of the injury corresponds to the following:
Grade I: Partial tears of the PCL.
Grade II: Isolated, complete tear to the PCL.
Grade III: Tear of the PCL with other associated ligament injury.
What is the treatment?
Unlike ACL tear, treatment for PCL tear is quite controversial where there is little agreement as how best to proceed. Initial treatment includes the use of crutches, ice and elevation and treating the pain and swelling.
Once these symptoms have cleared, physical therapy is beneficial to improve knee motion and strength. For most grade I and grade II PCL tears, non-operative treatment is recommended.
Surgical reconstruction of the PCL is controversial, and usually only recommended for grade III PCL tears. Some orthopedic surgeons do not see the benefit of PCL reconstruction due to the technical difficulty of the surgery. Others, however, believe PCL reconstruction can lead to improved knee stability and reduced likelihood of problems down the road.
Surgical PCL reconstruction is difficult partly because of the position of the PCL in the knee. Trying to place a new PCL graft in this position is difficult, and over time these grafts are notorious for stretching out and becoming less functional.
Generally, surgical PCL reconstruction is reserved for patients who have injured several major knee ligaments, or for those who cannot do their usual activities because of persistent knee instability.
Options for how to perform ACL knee surgery.
Graft selection is the most significant choice used to reconstruct the torn ACL. There are also variations in the procedure, such as the new ‘double-bundle’ ACL reconstruction.
Besides infection, the risks of ACL surgery include persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. However, the good news is that over 90% of patients have no complications with ACL surgery.
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