Posterior Cruciate Ligament Injury
What is PCL injury?
PCL injuries often occur as part of the knee injury and is the least common ligamentous injuries among the four major ligaments of the knee. PCL injuries often occurs in isolation due to the structural positions. Most of the patients able to tolerate the PCL deficient knee and continue their daily activities but there will complications if its left untreated. Studies have indicate good outcomes of non-operative management in terms of returning to high levels of play and functions.
Basic Structure and Function of PCL
The Posterior Cruciate Ligament is made of tough fibrous material and function to control excessive motion by limiting joint mobility. The main function of PCL is to limit the posterior translation of the knee, resist hyperextension and provides a rotational axis and stability. It originates from the medial aspect of the medial femoral condyle and branches into two bundles before inserting into the posterior aspect of the tibia.
A PCL tear occur when a direct blow to the front of the knee or leg below the knee and this puts a significant amount of stress on the PCL. When the PCL stretches to the point of mechanical failure which is considered a tear. This commonly happen when someone is tackled in football below the knee from the front and the person lands on the knee forcefully with their knee bend. It can happen in a motor vehicle accidents as well when there is a head-on collision and hard strikes directly against the knee.
Non- Operative Rehabilitation
When considering non-operative management for PCL, it’s important to discuss short and long term goals with the patient for optimal decision making.
Basically, to allow ligament to heal in a neutral position, there are a few essential precaution and guidelines to follow:
- Avoid hyperextension for 12 weeks
- Prevent posterior tibial translation for 12 weeks (no hamstring strengthening)
- PCL brace is to be worn x 12 weeks
- PCL loading occurs at higher knee angles. It is prudent to use smaller knee angles (0-50 degree) before progressing to larger knee angles (50-100 deg.) because PCL forces generally increase as knee angle increases.
- When working on improving the ROM, prescribe exercises from a prone position to limit the effect of gravity.
- Limit WB initially to restore joint homeostasis if the injury is accompanied by effusion and joint bleeding.
- Limit isolated hamstrings contraction at greater than 15 degrees knee flexion for at least 16 weeks as it was found to increase the load on PCL.
When might surgery be required?
Surgery for a ruptured posterior cruciate ligament is often required when other structures in the knee are also damaged. For example, the anterior cruciate ligament, medial collateral ligament or lateral ligament sprains.
Also, if you have rotational laxity in your knee. This means your lower leg twists more than normal in relation to the upper leg (femur).
Post-Surgical PCL Physiotherapy Rehabilitation
Post-operative PCL repair rehabilitation is one of the most important aspects of PCL reconstruction surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.
Your rehabilitation following PCL surgery focuses on restoring full knee motion, strength, power and endurance. While protecting the healing repaired ligament in the early phase. You’ll require proprioception, balance and agility training that is individualised towards your specific sporting or functional needs.
Here in Healthworks, the physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at firstname.lastname@example.org