Posterior Cruciate Ligament Tear

From Economou SG, Economou TS:
Instructions for Surgery Patients. Philadelphia, WB Saunders, 1998, p. 377.

Description
Posterior cruciate ligament tear is a sprain (tear) of one of the four major ligaments of the knee. The posterior cruciate ligament (PCL) is a ropelike structure that helps keep the normal position of the femur (thigh bone) and the tibia (leg bone), so that the leg bone does not slip back over the femur. This ligament is the largest and strongest within the knee. When torn, this ligament may heal in a lengthened (stretched out) position or it may attach to other structures of the knee via scar tissue.

Common Signs and Symptoms – Notify a physician if you have any of the following:

A pop heard or felt at the time of injury, an inability to continue activity after the injury and significant knee swelling noticed within 6 to 8 hours after the injury

Inability to straighten knee

Walking with a limp and knee giving way or buckling, particularly the first several months after injury

Occasionally, locking when there is concurrent injury to the meniscus cartilage

Diffuse knee pain, usually in the front half of the knee, behind the kneecap or in the very back of the knee; pain above or below the kneecap

Pain that is worse with sitting for long periods, when rising from a sitting position, when going up or down stairs or hills, when kneeling or squatting, and when wearing shoes with heels; often, pain with jumping

Usually achy pain, but may be sharp

Difficulty running backward or backpedaling

Treatment
Initial treatment consists of ice and anti-inflammatory medication to relieve pain and reduce the swelling of the knee. Walking with crutches until you walk without a limp is often recommended (you may put full weight on the injured leg). Range-of-motion, stretching, and strengthening exercises may be carried out at home, although usually referral to a physical therapist or athletic trainer is recommended. Occasionally your physician may recommend a knee brace, especially if other ligaments are injured along with the PCL. The PCL has a complex structure and as yet cannot be replicated with surgery. Rehabilitation of PCL tears usually concentrates on reducing knee swelling, regaining knee range of motion, regaining quadriceps muscle control and strength, functional training, bracing (rarely), and education. For severe PCL injuries, particularly those associated with other injuries to the knee, surgical reconstruction (replacement with a graft) may be recommended. Surgery may also be recommended for patients with chronic PCL tears who continue to have symptoms 6 to 12 months after injury. Surgical reconstruction rarely restores complete knee ligament tightness. If the ligament pulls a piece of bone off with it, it is not where it belongs, and the bone is large enough, surgery to replace the bone where it belongs and attach it with a screw, staples, stitches, or pins is often performed.

RICE Principle
With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

Rest- Walk with crutches if you cannot bear weight or it is very painful.

Ice- Use an ice pack for 20 minutes every two to three hours during the first 72 hours.

Compression- Use an ace wrap on the knee. Start at the top of the calf and wrap to mid-thigh.

Elevation- Keep the injured leg above the level of the heart when you are sitting or lying down