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Posterior Cruciate Ligament

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What is Posterior Cruciate Ligament?

The posterior cruciate ligament, or PCL, is one among four ligaments which provide stability of the knee joint . PCL  sits just  behind the ACL (Anterior cruciate ligament).PCL injuries are less common than ACL injuries also, ACL injuries are more commonly diagnosed ,while  many PCL injuries are left undiagnosed . The role of  PCL is to  prevents the tibia (leg  bone) from sliding too far backwards. Along with the ACL  it helps in keeping tibia in position below the femur (thigh bone).

Causes of PCL injury?

 Dashboard injury is the most common mechanism of  PCL injury. This  injury occurs when the knee is bent, and an object forcefully strikes the leg  backwards. It is known as dashboard injury because it occurs mostly  in car collision where leg bone hits the dashboard of car  to cause this injury .while in our country commonest motorcycle/two wheeler accident where bend knee hits on a coming object.

The other common mechanism of injury occur when a person  falls on the front of their knee when his knee is hyper-flexed  with the foot  pointing downwards. These types of injuries produce force which is  sufficient to cause PCL injury. This injury most often occurs in athletes when they fall down .

Sometimes even simple mis-steping of foot while walking  can cause PCL injury.

Patients complaints in PCL injury?

 The most common symptoms of a PCL tear are

1.      Patient complain of pain in his affected knee.

2.       Swelling.

3.       Decrease range of motion.

4.      Giving away of  knee or knee popped out.

5.      Rarely complain of knee instability  (which is common in ACL injury . If this complaint of instability is a problem then surgery is indicated).

 Diagnosing a case of PCL injury?

H/o of injury-

Its important to know how injury occur? Limb was in which position? This will help Doctor at A+ clinic  in looking at mechanism of injury which is part of making the diagnosis of a PCL tear .

Specific maneuvers can examine the function of the PCL -

Posterior drawer test

Radiograph - X-rays are necessary  to rule out associated bony fracture-

MRIs are also helpful in making the diagnosis and detecting any other structures of the knee  and other ligament injuries or cartilage damage when a PCL tear is found.

Grading of PCL injury-

PCL tears are graded on the basis of severity of injury from  grade I  to grade III. The grade is calculated by the extent of laxity measured during your examination.

Grade I:: Less than 5 mm of backward movement of leg bone  

Grade II: 5-10 mm of backward movement of leg bone          

Grade III:

Also can be classified according to the stationn

Station 1 – Normal position leg bone in front of thigh bone

Station 0 – Mild posterior sagging till thigh bone

Station -1 –leg bone sagging beyond thigh bone

What is the treatment for a PCL tear?

Treatment of PCL tears is now very common, and, unlike treatment of an ACL tear there is little agreement as how best to proceed. Initial treatment of the pain and swelling consists of the use of crutches, ice, and elevation.

Conservative management –

  • Non-operative treatment is recommended for most isolated  partial PCL tear.

  • Advice Rest to affected knee ..

  • Apply Ice on that knee.

  • Apply knee Compression support

  • Elevate the affected limb to decrease swelling.

  • Anti inflammatory drugs .

  • Massage to decrease swelling and relax surrounding muscular tension

  • Manual therapy 

  • Once pain has subsided, physiotherapy  to restore the range of movement, improve balance and maintain quadriceps strength .

Surgical Treatment

Surgical reconstruction of the PCL  has seen lot of changes over the period of time. Now for complete tear ,physically active and those having  sign of instability and knee pain following PCL injury PCL Reconstruction is needed.

Procedure :

Arthroscopic procedures  are less invasive techniques include less pain from surgery, less duration of stay in the hospital . Only  Two minimal incision are required  to rebuild a posterior cruciate ligament is done.

PCL reconstruction can lead to improved knee stability and lower the chances of problems in daily routines at later time. .

Surgical PCL reconstruction can be done by using either single bundle (Anterolateral component)or double bundle graft(Both anterolateral and posteromedial component).Single bundle Technique  requires single tunnel for both the bundles  of PCL but in double bundle two tunnel are required separate for each bundle. Double bundle is technically difficult as compare to single bundle. But results of both are comparable.

Rehabilitation

Rehabilitation has a major role after  both conservative as well as surgical management in getting back to their normal routines. Physiotherapy will start  1 to 4 weeks after your procedure.

After surgery It will  take around 6-8weeks to return back to previous job. Full recovery typically requires 6 to 12 months.

Although it is a slow process, commitment of patient to physiotherapy is the most important factor in returning to all the  daily routine activities .

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