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PCL Injury
Dr. Ambrose Yung
What is a Posterior Cruciate Ligament (PCL) Injury?
A PCL injury refers to damage to the ligament located at the back of the knee.
The PCL connects the thigh bone (femur) to the shinbone (tibia) and helps stabilise the knee joint by preventing the tibia from moving too far backwards. PCL injuries typically occur due to direct trauma or force applied to the knee, often from sports, accidents, or falls. These injuries can lead to knee pain, swelling, and a feeling of instability in the joint.
Types of PCL Injury
PCL injuries are classified into different grades based on the extent of ligament damage and how far the shinbone moves backwards in relation to the thighbone.
Grade I
A partial tear of the PCL. The knee is still relatively stable, and the shinbone moves slightly backward but stays in front of the thighbone. This injury can often be treated without surgery through rest, physical therapy, and strengthening exercises.
Grade II
A complete tear of the PCL. The shinbone moves further back and is level with the thighbone, indicating a more serious injury. Treatment may involve physical therapy, but surgery may be necessary if the knee is unstable.
Grade III
Grade III injuries involve the PCL and other knee ligaments, such as the ACL (anterior cruciate ligament). In this case, the shinbone moves far behind the thighbone, causing significant knee instability. Surgery is usually required to repair the PCL and any other damaged ligaments, followed by a long rehabilitation process.
Causes of PCL Injury
PCL injuries are frequently caused by specific types of trauma or stress on the knee. Common causes include:
- Direct Impact or Trauma: A PCL injury commonly occurs when there is a direct blow to the knee, particularly when it is bent. This can happen in car accidents (when the knee strikes the dashboard) or in sports, such as football, during tackles or falls.
- Hyperextension: A forceful overextension of the knee, pushing the joint beyond its normal range of motion, can stretch or tear the PCL.
- Falls on a Bent Knee: Falling directly onto a bent knee can cause the shinbone to move backwards too far, damaging the PCL. This is common in sports like skiing or when slipping on wet surfaces.
Symptoms of PCL Injury
PCL injuries can cause various symptoms, which may appear immediately after the injury or gradually over time. Common symptoms include:
- Knee Pain
When the PCL is damaged, it causes pain in the back of the knee, particularly when bending or applying pressure to it, such as while walking or climbing stairs. - Swelling
The injury causes inflammation, resulting in swelling around the knee joint, which may restrict movement. This swelling typically develops within hours of the injury. - Instability
The knee may feel loose or unstable, especially when walking or descending stairs. This is because the PCL can no longer provide adequate support to the knee joint as before. - Reduced Range of Motion
Swelling and damage to the PCL can restrict the ability to fully extend or bend the knee. Stiffness may develop as the muscles around the knee tighten in response to the injury. - Difficulty Bearing Weight
In more severe injuries, the knee may not be able to support the body’s weight effectively. Without the PCL’s stabilising function, the knee may feel like it could give way or buckle when standing or walking.
Diagnosis
Diagnosing a PCL injury involves a thorough examination of the knee and specific imaging tests to confirm the extent of the damage.
- Physical Examination: The doctor examines the knee for signs of instability, swelling, and tenderness. Specific movements such as pushing the shinbone backwards may be used to assess knee stability and check for excessive movement, which may indicate a PCL injury.
- Imaging Tests: An MRI provides detailed images of the ligament and surrounding tissues. While X-rays do not show soft tissues like ligaments, they may be used to rule out fractures or other bone-related issues that cause similar symptoms.
- Arthroscopy: In rare cases, arthroscopy may be used to examine the PCL and other structures within the knee. This minimally invasive procedure involves inserting a small camera into the knee joint, providing a clear view of ligament damage. Arthroscopy can also allow for immediate treatment if necessary.
Treatment Options
Non-Surgical Treatment
For mild to moderate PCL injuries, non-surgical treatments are often effective in relieving symptoms and preventing further injury.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly used to reduce pain and inflammation around the injured ligament. However, long-term use should be monitored due to potential side effects.
Physical Therapy
Targeted exercises strengthen the muscles around the knee, which support the knee joint and relieve pressure on the damaged PCL. Physical therapy improves stability and promotes recovery, helping to restore normal knee function. Following a proper rehabilitation programme is necessary, as performing exercises incorrectly or overdoing them can aggravate the injury, potentially causing further damage.
Surgical Treatment
Surgery is recommended for complete PCL tears, combined injuries involving cartilage and/or bone, or when non-surgical methods fail to restore knee function and stability.
PCL Reconstruction
A graft is used to replace the torn ligament, usually taken from the patient’s own tissue (such as a tendon) or from a donor. This procedure helps restore knee stability and function. However, recovery can be lengthy, often requiring several months of rehabilitation to regain strength and mobility.
Arthroscopy
PCL reconstruction is often performed arthroscopically, using small incisions to access and treat the injury. This minimally invasive approach typically involves shorter recovery times and less scarring than traditional open surgery, as well as minimal tissue disruption.
Prevention of PCL Injury
Preventing PCL injuries involves strengthening the muscles around the knee to improve stability and reduce ligament strain. Regular exercise, supportive footwear, and proper form during physical activities can lower the risk. Athletes in high-contact sports may benefit from protective gear, such as knee braces or pads, to minimise direct knee trauma, while avoiding excessive stress and hyperextension of the knee joint also helps protect the PCL.
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6 Napier Road #08-04
Singapore 258499
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
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Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
Can you have a PCL injury without realising it?
Yes, in some cases, mild PCL injuries might go unnoticed initially, especially if the symptoms are not severe. Sometimes, there is only slight discomfort or swelling, and the knee may appear stable at first. However, over time, the knee may become more unstable or painful, indicating an injury.
What should I do if I suspect I have a PCL injury?
If you suspect a PCL injury, stop physical activity to prevent further damage. Apply ice to the knee to reduce swelling, elevate your leg, and avoid putting weight on the knee. Seek medical attention for a proper diagnosis and to determine the extent of the injury.
Can I lead an active life with a PCL tear?
Yes, many people with mild to moderate PCL tears can lead active lives with proper treatment, which includes physical therapy. However, in cases of severe tears, surgical intervention may be required to restore full function, especially for those who participate in high-impact sports or have physically demanding jobs.