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Posterior Cruciate Ligament Injury

(PCL Tear)

Definition

The posterior cruciate ligament (PCL) is connective tissue located within the knee. The PCL connects the thighbone to the shinbone. This connection keeps the shinbone from moving too far backward, stabilizing the knee.
Posterior Cruciate Ligament
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Copyright © Nucleus Medical Media, Inc.

Causes

The PCL ligament can become strained or torn when a strong force is applied to it. This force can occur during sports or other high-stress activity.

Risk Factors

Factors that may increase your chance of injuring the PCL include:
  • Sports injury
  • Motor vehicle accident
  • Fall on a bent knee
  • Strong force to the leg immediately below the kneecap
  • Knee dislocation

Symptoms

A PCL tear may cause:
  • 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

You will be asked about your symptoms and medical history. A physical exam will be done.
Images may need to be taken of the internal structure of your knee. This can be done with:
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
To reduce pain and swelling, apply an ice 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 pack in a towel.
Pain Relief Medications
To manage pain, your doctor may advise:
  • Over-the-counter medication, such as ibuprofen and naproxen
  • 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

Physical Therapy
Your doctor may refer you to a physical therapist. Therapy can help control discomfort and promote recovery.
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.

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

Some steps that may help decrease your chance of getting a PCL injury include:
  • 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 August 2013. Accessed February 28, 2014.

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 February 28, 2014.

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 February 28, 2014.

Posterior cruciate ligament (PCL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 13, 2014. Accessed February 28, 2014.

10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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