Posterior Cruciate Ligament (PCL) Injuries

The posterior cruciate ligament (PCL) is one of four ligaments that work together to limit excess movement in the knee joint. PCL tears usually result from high-force impacts, generally vehicular accidents or contact sports such as football, soccer, or hockey. PCL injuries also can occur in non-contact sports, such as gymnastics or skiing, but are much less common.

Unlike the “pop” and severe pain that may occur with a torn anterior cruciate ligament (ACL), an isolated PCL injury may manifest itself simply as swelling in the knee that subsides over a few days or weeks.

Diagnosis

Diagnosis of a PCL injury begins with an extensive patient history to learn how the injury occurred. The physician must determine what position the leg was in at the time of injury and whether the injury involved contact or a non-contact mechanism. In an acute, isolated PCL injury, there is usually a history of mild pain and swelling. If the PCL and one or more other knee ligaments are torn, the knee is severely swollen and the patient is completely disabled.

Once a thorough history is obtained, the physician performs a physical exam of the knee to assess the stability of the ligaments. Using specific tests, the physician can diagnose PCL injuries by applying force to the knee and feeling for abnormal motion. Obtaining additional studies such as x-rays and an MRI, can be very helpful to give an accurate picture of the extent of the injury.

Treatment

Treatment for a PCL injury depends on the extent of injury, the patient’s age, and the desired level of activity. A young, professional athlete with a complete PCL tear may require surgery, whereas a sedentary, middle-aged individual with a partial tear may go directly into rehabilitation. Nonoperative treatment involves exercises specifically designed to improve strength, flexibility, and balance. A brace may be prescribed, but unlike ACL-deficient knees, PCL injuries benefit little from braces.

Prevention

Unfortunately, most PCL injuries happen during accidents that usually aren't preventable. But these suggestions may help you avoid an injury:

  • Perform strengthening exercises for your upper leg muscles (quadriceps and hamstrings), which protect your knee.
  • Maintain a proper stretching routine.
  • Use proper techniques when playing sports or exercising.

Rehabilitation

The goals of rehabilitation are to restore range of motion and to strengthen the quadriceps muscles, which help stabilize the knee. Precautions you can take at home for minor PCL injuries include:

  • Reduce activity during the acute phase.
  • Ice the injury multiple times per day.
  • Compress the knee with a bandage or wrap.
  • Elevate the knee above the level of the heart.
  • Use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed recovery.

Rehabilitation Exercises

  • Quad sets: Sit with legs extended and fully contract the muscles of the front thighs. Hold contractions for 10 seconds. Repeat 10 times for three sets.
  • Straight leg raises (hip flexion): Lie with one leg extended and the other bent at the knee. Lift the entire leg from the hip so that the heel is about five inches above the floor. Hold this position for five to 10 seconds and then slowly lower the leg. Repeat 10 times for three sets.
  • Backward leg raise (hip extension): Lie on stomach with legs straight. Lift one leg as high as possible and hold for five to 10 seconds, then slowly lower the leg. Repeat 10 times for three sets.
  • Hip abduction: Lie on side of uninjured leg, so that the injured leg is on top of the uninjured leg. Lift the injured leg at the hip away from the body. Lift the leg as high as possible and hold for five to 10 seconds, then slowly lower the leg. Repeat 10 times for three sets.
  • Hip adduction: Lie on side of injured leg, with uninjured leg bent at the knee and foot flat on the floor. Lift the injured leg at the hip toward the other leg. Hold for five to 10 seconds and then slowly lower the leg. Repeat 10 times for three sets.
  • Half knee bends: Stand with feet shoulder width apart. Slowly lower the body weight by bending the knees. Do not perform a full squat, but rather stop at about half of the full squat position and then fully extend the knees. If there is pain before achieving the half-squat position, stop downward travel at that point. Repeat 10 times for three sets.
Content on this page is for informational purposes only. If injured, please consult a physician.

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