by Kohnle D
(PCL Tear)
Definition
The posterior cruciate ligament (PCL) is a piece of connective tissue located within the knee. The PCL connects the thighbone to the shinbone. This connection keeps the shinbone from moving too far backward, and stabilizes the knee.
The PCL ligament can become strained or torn when a strong force is applied to it. This can happen during sports or other high-stress activity.
Treatment depends on the severity of the injury.
Causes
Injury to the PCL can be caused by a variety of events, including:
- Sports injury
- Motor vehicle accident
- Fall on a bent knee
- Strong force to the leg immediately below the kneecap
- Knee dislocation
Risk Factors
The following factors increase your chance of injuring the PCL:
- Playing sports
- Previous knee injury, including dislocation
Symptoms
Symptoms may include:
- Pain and swelling in the knee
- Soreness in the area behind the knee
- Weakness or instability in the knee
- Difficulty walking
- Pain when moving the knee
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will need to see images of your knee.
Tests may include:
Ligament sprains are graded according to their severity:
- Grade 1—Mild ligament damage.
- Grade 2—Partial tearing of the ligament.
- Grade 3—Complete tearing of the ligament.
Treatment
Talk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:
Acute Care
Rest
Your ligament will need time to heal. Avoid activities that place extra stress on the knee:
- Do not do activities that cause pain. This includes running, jumping, and weight lifting using the legs.
- Do not play sports until your doctor has said it is safe to do so.
Your doctor may recommend a knee brace to stabilize the knee, and crutches to keep extra weight off your leg.
Cold
Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.
Pain Relief Medications
To manage pain, your doctor may recommend:
- Over-the-counter medication, such as
aspirin,
ibuprofen, or
acetaminophen
- Topical pain medication—creams or patches that are applied to the skin
- Prescription pain relievers
Compression
Compression can help prevent more swelling. Your doctor may recommend an elastic compression bandage around your knee. Be careful not to wrap the bandage too tight.
Elevation
Elevation can also help keep swelling down. Keep your knee higher than your heart as much as possible for the first 24 hours or so. A couple of days of elevation might be recommended for severe sprains.
Recovery Steps
Heat
Use heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the ligament.
Stretching
When the acute pain is gone, start gentle stretching as recommended. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times. Stretch several times a day.
Strengthening
Begin strengthening exercises for your ligaments as recommended.
If you are diagnosed with a PCL injury, follow your doctor's
instructions.
Surgery
Surgery may be needed to fully restore function of the knee. The decision to have surgery should be made after discussion with your doctor about your athletic needs, age, and associated factors.
Prevention
Most PCL injuries occur during accidents that are difficult to prevent. To reduce your chance of injuring the PCL, take these steps:
- Protect your knees by doing regular strengthening exercises for your thighs.
- Maintain proper technique when exercising or playing sports.
RESOURCES
American Academy of Orthopaedic Surgeons
http://orthoinfo.org
American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org
CANADIAN RESOURCES
Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org
References
Knee sprains and meniscal injuries. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/fractures%5Fdislocations%5Fand%5Fsprains/knee%5Fsprains%5Fand%5Fmeniscal%5Finjuries.html. Updated February 2012. Accessed May 3, 2012.
Ligament injuries to the knee. John Hopkins Medicine website. Available at. http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/orthopaedic%5Fdisorders/ligament%5Finjuries%5Fto%5Fthe%5Fknee%5F85,P00926/. Accessed May 3, 2013.
Posterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00420.
Updated February 2009. Accessed May 3, 2013.
Posterior cruciate ligament (PCL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 11, 2013. Accessed May 3, 2013.
10/26/2010 DynaMed's Systematic Literature Surveillance
DynaMed's Systematic Literature Surveillance: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults.
Cochrane Database Syst Rev.
2010;(6):CD007402.