Posterior cruciate ligament tear

Rupture of the posterior cruciate ligament

The posterior cruciate ligament (PCL) is one of the central stabilisers of the knee joint. It runs inside the knee from the back of the shin bone to the thigh bone and prevents the shin bone sliding backwards against the thigh.

What happens when the posterior cruciate ligament tears?

Definition

Injuries of the posterior cruciate ligament usually arise from a direct force on the bent knee – in a car accident, where the lower leg strikes the dashboard (a "dashboard injury"), or in a fall onto the bent knee. Sports such as football, skiing or handball are also frequent causes. The injury often occurs on its own, but sometimes together with other ligament or meniscal damage.

Complaints and symptoms

Unlike tears of the anterior cruciate ligament, injuries of the posterior cruciate ligament are frequently less painful. Typical symptoms are a feeling of instability – above all when walking downhill or on stairs – and a diffuse swelling of the knee. Some people report the leg occasionally "giving way". In chronic cases the instability can lead to pain under load or even to cartilage damage.

Diagnosis and imaging

Diagnosing a PCL injury calls for a careful clinical examination, for instance with the drawer test at 90° of knee flexion. As the pain is frequently only slight, a PCL injury can easily be overlooked. MRI is therefore the imaging method of choice, in order to establish the extent of the injury and any accompanying damage precisely. In certain cases – with older injuries, for example – an additional X-ray under load may be needed.

Symptoms

Typical complaints are a feeling of instability, above all when walking downhill or on stairs, and a diffuse swelling of the knee.

Pain

The tear of the ligament and the instability are often experienced as very painful

Instability

A rupture of the posterior cruciate ligament lets the lower leg slide backwards more than it should

Effusion

The tear of the posterior cruciate ligament and the accompanying injuries make the joint swell

The knee joint in detail

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Treatment options for tears of the posterior cruciate ligament

Non-surgical

With incomplete or isolated tears, and in less active patients, non-surgical treatment is often very successful. The knee is first immobilised in an extension splint; later a special dynamic brace is used, which controls the load on the posterior cruciate ligament. Targeted physiotherapy accompanies this, focused on building up the thigh muscles. The aim of treatment is to restore the stability and function of the knee joint without an operation.

Surgical

With complete tears, or where instability persists despite non-surgical treatment, a surgical reconstruction may be necessary. The posterior cruciate ligament is replaced with the patient's own tendons (usually from the back of the thigh). Aftercare is similar to non-surgical treatment – with a static brace at first, later a dynamic one, followed by physiotherapy. Full sporting load is generally reached after around 9 months.

Expertise at Sportklinik Freiburg

At Sportklinik Freiburg we have many years of experience in treating posterior cruciate ligament injuries. We carry out a large number of PCL reconstructions every year and support our patients with a high level of expertise through diagnosis, treatment and rehabilitation.