A posterior cruciate ligament rupture or injury usually occurs during sports or a sudden movement. Symptoms include pain in the knee, swelling, limitation of movement and loss of stability in the knee. The diagnosis is usually made by examination and imaging methods such as MRI and X-rays.
Treatment depends on the degree of damage to the posterior cruciate ligament and whether there are other injuries to the knee. In the non-surgical treatment of posterior cruciate ligament injury, methods such as physiotherapy and the use of special knee braces are used. Posterior cruciate ligament surgery is performed arthroscopically just like anterior cruciate ligament surgery. Early diagnosis and appropriate treatment can speed up the healing process and help the knee regain its former function.
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What is the Posterior Cruciate Ligament?
This ligament, located at the back and middle of the knee, is known as the posterior cruciate ligament or posterior Criciate Ligament (PCL). It is one of several ligaments that connect the thigh bone (femur) to the shin bone (tibia). The posterior cruciate ligament is the strongest ligament of the knee and therefore occurs less frequently than about 3% of all knee injuries.
The function of the posterior cruciate ligament is to prevent the tibia from sliding backwards. The function of the anterior cruciate ligament is to prevent the tibia from sliding forward.
Where is the Posterior Cruciate Ligament?
The posterior cruciate ligament (PCL) is a ligament within the knee joint that provides stability to the knee. It runs from the front to the back of the knee and connects the femur (thigh bone) to the tibia (shin bone).
Symptoms of a Posterior Cruciate Ligament Tear
A feeling of abnormal movement and pain in the knee when slowing down after accelerating while running, when descending stairs and slopes, or when stopping suddenly.
Pain with movements such as twisting, turning or rotating around its axis, a feeling of slipping in the knee.
Pain in the anterior aspect of the knee
Symptoms of Posterior Cruciate Ligament Injury
Generally, a posterior cruciate ligament injury is characterized by the following symptoms
Pain in the knee A posterior cruciate ligament injury can cause pain in the back of the knee. This pain can often be concentrated in the area of the injury.
Knee swelling There may be swelling in the knee after an injury. This swelling may vary depending on the severity of the injury.
Feeling of instability in the knee: Injury to the posterior cruciate ligament can affect the stability of the knee. Therefore, some patients may experience a feeling of instability in the knee following the injury.
Frequent locking sensation in the knee: After an injury, there may be frequent locking or sticking sensations in the knee. This can be associated with impaired function of the cruciate ligament.
Limitation of movement in the knee: Patients with a posterior cruciate ligament injury often experience limitation of movement in the knee. This limitation may be especially evident during bending and straightening movements of the knee.
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How Does a Posterior Cruciate Ligament Tear Occur?
Posterior cruciate ligament injury is usually caused by a strong force. However, posterior cruciate ligament injury most often occurs after sports trauma. It can also occur after the bent knee hits a very hard object.
Posterior cruciate ligament injury causes
As a result of his knee hitting the dashboard in a car accident.
A football player who falls on his knee while his knee is bent.
It may even be the result of falling hard on your knee on the floor at home.
How is Posterior Cruciate Ligament Tear Diagnosed?
After listening to the patient's detailed history, a posterior cruciate ligament tear is suspected, especially from the mechanism of the injury. Then, after a detailed physical examination, a diagnosis of posterior cruciate ligament injury is made with tests such as a special X-ray (in a sitting position), MRI imaging and Computed Tomography.
In general, most incomplete posterior cruciate ligament injuries heal over time. If posterior cruciate ligament injuries are diagnosed early and the use of appropriate knee braces is started on time and the patient pays utmost attention to this treatment, the posterior cruciate ligament can heal properly. Otherwise, the ligament cannot function as it will heal by lengthening.
Although MR imaging is very good for the evaluation of acute injury, it may appear normal in chronic posterior cruciate ligament tears. In a chronic tear, the tendon heals prolonged. In this case, a stress x-ray is necessary to diagnose the extent of the tear.
Grading of Posterior Cruciate Ligament Tear
Grade 1: Small partial tear
Grade 2: Near-total tear
Grade3 : Complete tear, in this injury the posterior cruciate ligament has no function and there are often injuries to other structures in the knee (most commonly posterolateral corner injury)
How is a Posterior Cruciate Ligament Injury Treated?
There are two treatment options for this condition:
Non-Surgical Treatment of Posterior Cruciate Ligament Tear
Treatment of Posterior Cruciate Ligament Tear with Surgery
How is Posterior Cruciate Ligament Rupture Treated Without Surgery?
If the posterior cruciate ligament tear is alone and there is no other injury in the knee and the level of injury is 1st and 2nd degree, I do not operate on my patients, I apply the following protocol.
Use of a proper knee brace. A special knee brace holds the knee joint in a normal position, allowing the ligament to heal without putting stress on the posterior cruciate ligament.
A rehabilitation program aimed at strengthening the quadriceps muscle should be started immediately.
Treatment of Posterior Cruciate Ligament Rupture with Surgery
The treatment of posterior cruciate ligament tears usually requires surgical intervention. During surgery, the torn ligament is repaired or reconstructed.
This is done to restore stability to the knee and prevent damage to the joint. The rehabilitation process after surgery is important and our patients usually participate in physiotherapy programs.
In Which Situations Is Posterior Cruciate Ligament Reconstruction Surgery Performed?
In particular, posterior cruciate ligament surgery is performed under the following conditions
If the backward displacement of the injured knee compared to the intact knee is more than 10 mm.
If there is a 3rd degree injury or rupture.
If there are other injuries to the knee (most commonly a posterolateral corner injury)
In some cases the posterior cruciate ligament does not rupture, but a bone fragment separates from where the ligament attaches to the tibia. This is called avulsion fracture. The treatment is to fix the bone fragment with screws.
How is Posterior Cruciate Ligament Surgery Performed?
First of all, posterior cruciate ligament surgery is performed with a closed surgery technique. It is prepared by removing the hamstring tendons from the inner side of the knee. Then, tunnels are opened in the knee, femur and shin bone.
A third camera entrance is opened to see the exit of the tunnel opening into the shin bone. After the tunnels are opened with special guides, the prepared tendon grafts are passed through the tunnels and stretched appropriately. The tendon graft placed in the tunnel is fixed in a special position with metal buttons and sometimes screws.
When does a posterior cruciate ligament injury recover?
Grade 1 injury: 10-14 days
Grade 2 injury: 3-4 weeks
Grade 3 injury: 9-12 months, if PCL reconstruction surgery is performed.
How is Posterior Cruciate Ligament Reconstruction Surgery Performed?
Posterior cruciate ligament surgery is performed arthroscopically. Hamstring tendons are taken from the inner side of the knee and prepared. Then tunnels are opened to the thigh bone and tibia in the knee.
An additional portal is opened to see the exit of the tunnel in the tibia. After the tunnels are opened with special guides, the prepared tendon grafts are passed through the tunnels and stretched appropriately. The tendon graft is fixed in a special position with metal buttons and sometimes screws.
Recovery Process After Posterior Cruciate Ligament Surgery
After the operation, the patient must use crutches and a knee brace for 6 weeks. After the 6th week, the load is gradually given and the single crutch is left. Between the 7th and 8th week, the 2nd crutch is also left. For the first 4-6 months, the patient should receive 3-4 sessions of physiotherapy per week.
Conclusion
Posterior cruciate ligament (PCL) injury and rupture is a serious knee problem that usually occurs as a result of sports activities or sudden movements. There are often other injuries in the knee that accompany a posterior cruciate ligament injury. Such injuries can cause symptoms such as pain, swelling, limitation of movement and loss of stability in the knee.
The diagnosis can be made with a detailed physical examination and various imaging techniques. Treatment methods vary depending on the severity of the injury and other possible damage to the knee. Non-surgical treatment options are preferred for mild and moderate injuries, while serious injuries usually require surgery. Early diagnosis and appropriate treatment can speed up the recovery process and allow the knee to regain its former function.
Patients' active participation in the treatment process and regular attendance at physiotherapy sessions are critical for a successful recovery. Therefore, posterior cruciate ligament injuries should be taken seriously and the necessary medical attention should be sought in a timely manner.
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