How to Recover from a Posterior Cruciate Ligament Injury

The posterior cruciate ligament (PCL) is one of four crucial ligaments supporting your knee joint and the largest intraarticular ligament. It prevents your shinbone from sliding backward too far. When injured, it can significantly impact your ability to move your knee back and forth.

Posterior cruciate ligament injuries are relatively common, making up 5% to 20% of knee ligamentous injuries. This wide range highlights the diverse nature of these injuries and the various factors influencing their occurrence. Fortunately, there is a way for proper and fast recovery.

In this article, we will lay out proven methods on how to recover from posterior cruciate ligament injury. We will also understand its anatomy, types, triggers, symptoms, diagnosis, and how it differs from other ligament injuries.

What Is a Posterior Cruciate Ligament Injury

The PCL is a thick, strong ligament located inside the knee joint. It runs from the back of the thighbone (femur) to the front of the shinbone (tibia). Think of it as a hinge in the knee. The PCL is one of the primary structures that holds this hinge together, preventing excessive backward movement of the shinbone. When you bend your knee, the PCL stretches. When you straighten your knee, it relaxes.

PCL injuries occur when this ligament is stretched beyond its normal capacity, partially torn, or completely ruptured. This damage affects the stability of the knee joint, making it more prone to giving way.

How Does the PCL Get Injured?

You can incur PCL injuries in many ways. Severe knee trauma or powerful blows to the shinbone usually cause it. These injuries typically happen in car accidents and falls with a flexed knee. They can also happen when there's a sudden twist or hyperextension. Combined ligamentous injuries involving the anterior cruciate ligament (ACL), medial collateral ligament (MCL), or lateral collateral ligament (LCL), are also common.

Can You Walk After a PCL Injury?

It depends on the severity of the tear. For mild to moderate injuries, you might be able to walk with crutches or a brace. However, severe PCL tears or combined ligament injuries may require more significant restrictions. In these cases, your doctor will likely recommend exhausting your injured knee until it has healed sufficiently.

How Painful Is a PCL Injury?

The pain from a PCL injury also varies depending on the severity. When the injury is acute, meaning it just happened, pain often arises immediately accompanied by swelling. This initial discomfort can be quite noticeable.

On the other hand, chronic PCL injuries, which develop over time, might lead to a more gradual onset of pain. Instead of sudden severe pain, you might experience increasing discomfort and a growing sense of instability in your knee.

Note that individual pain tolerance varies, and what might be excruciating for one person might be manageable for another.

Types of PCL Injuries (Grades)

Physicians classify PCL injuries into three grades based on the severity of the damage to the ligament. Here's a breakdown:

Grade I

This is a mild sprain where the PCL stretches slightly but remains intact, similar to overstretching a rubber band.

Grade II

Partial posterior cruciate ligament tears occur in a Grade II injury. This means that some of the ligament fibres are ruptured.

Grade III

The most severe type, a Grade III injury involves a complete tear of the PCL. This significantly compromises the knee's stability.

Did You Know? Severe knee trauma that causes a PCL tear can potentially cause popliteal artery injury. Similarly, severe PCL injuries involving knee instability can affect the medial femoral condyle, a part of the femur that provides the bony attachment for the PCL.

Symptoms of a PCL Injury

A PCL injury often reveals itself through a combination of noticeable symptoms. Common symptoms of a PCL injury include:

• Mild to severe pain and discomfort in the knee
• Swelling and inflammation
• Stiffness and restricted movement in the knee
• Instabilityespecially when bearing weight or engaging in activities
• Difficulty walking or bearing weight
• Limited range of motionon your knee

Isolated PCL injuries are less common than those that occur in combination with other knee ligament or cartilage damage. This complexity can sometimes make diagnosing a PCL injury challenging.

Who Is More Prone to PCL Injuries?

Anyone can experience a PCL injury during unforeseen events like falls or a car accident. Generally, athletes are more prone to PCL injuries, especially in sports involving contact such as:

• Football
• Basketball
• Skiing
• Soccer
• Hockey
• Muay Thai
• Rugby

How Common Are PCL Injuries?

While PCL injuries are not as frequent as ACL injuries, they still represent a significant concern. Accurate statistics vary across different studies, but it's generally accepted that PCL injuries are less common than other knee ligament injuries, with an incidence rate typically below 20%.

How Is a PCL Injury Diagnosed?

To diagnose a PCL injury, your doctor will conduct a thorough physical examination. This often includes specific tests like the posterior drawer test, which helps assess the stability of the PCL.

Imaging studies also help confirm the diagnosis and determine the extent of the injury. X-rays can rule out bone fractures, while an MRI provides detailed images of the soft tissues. These images include the ligaments, allowing for a precise assessment of the PCL damage.

How Is a PCL Injury Treated?

The severity of the tear and your activity level still influence the treatment approaches for a PCL injury. Below are surgical and non-invasive treatment options for posterior cruciate ligament injury.

Non-Surgical Treatment

Most PCL injuries can be managed without surgery. A conservative approach, focusing on rest, immobilisation, and rehabilitation, often yields positive results.

1. Rest, Ice, Compression, and Elevation (RICE)

The initial phase of treatment typically involves RICE. This acronym represents soft tissue injury management:

• Rest: Avoiding activities that put weight or stress on the knee is crucial to allow the ligament to begin healing.
• Ice: Applying cold packs to the injured area helps reduce swelling and numb the pain.
• Compression: Wrapping the knee in an elastic bandage can minimise swelling and provide support.
• Elevation: Raising the leg above your heart level promotes fluid drainage and reduces swelling.

2. Knee Immobilisation

A prescribed knee brace can stabilise the injured knee and prevent further damage. The brace helps restrict excessive movement while allowing for some limited activity. The duration of immobilisation varies depending on the severity of the injury.

3. Physical Therapy

This is a strong treatment and rehabilitation method for a PCL injury. Physical therapy aims to restore strength, flexibility, and knee function. Phoenix Rehab creates a personalized treatment plan tailored to individual needs and injury severity. Our physiotherapist for knee pain in Singapore employs a variety of techniques, including:

• Strengthen the muscles surrounding the knee, particularly the quadriceps, hamstrings, and calves, which provide stability.
• Improve range of motion through exercises designed to regain full flexion and extension of the knee joint.
• Restore function through activities focusing on balance, coordination, and proprioception to prepare for return to normal activities.
• Flexibility training to restore normal knee movement.
• Balance and coordination drills for preventing future injuries.

To make this work more effectively, attend a physical therapy session consistently every week. Physiotherapy experts include post-treatment education in your plan to keep you in the loop about your condition and what you can do at home.

Surgery

In cases of severe PCL tears, combined ligament injuries, or persistent instability despite non-surgical treatment, doctors consider or advise surgery. PCL reconstruction is a surgical procedure to replace the damaged ligament with a graft. The graft can be harvested from different sources, including the hamstring tendons or the Bone-patellar Tendon Bone (BTB).

Common surgical interventions for posterior cruciate ligament injuries include:

• Standard arthroscopic procedure
• Open/posteromedial incision

The decision to undergo surgery is a significant one and should be made in close consultation with your healthcare provider. They will consider factors such as your age, activity level, and the specific characteristics of your injury. PCL injury patients will likely require surgery when:

• Pieces of bone tore off completely (complete PCL tear)
• Injury affects more than a single ligament
• Chronic PCL looseness

How Long Does a PCL Injury Take to Heal?

The healing time for a PCL injury varies significantly depending on the severity of the damage and treatment plan. Mild PCL injuries may heal within a few weeks with proper care, while more severe tears or those requiring surgical intervention can extend the recovery period to several months.

For non-surgical treatments, healing times can range from several weeks to a few months. Factors such as the patient's age, overall health, and adherence to the treatment plan influence recovery speed.

PCL reconstruction surgery typically requires a more extended recovery period. Patients can expect several months to a year of rehabilitation. The exact timeline depends on individual factors and the complexity of the surgery.

For both treatments, physical therapy remains the recommended rehabilitation. A comprehensive physical therapy programme will guide patients through exercises to rebuild the muscles supporting the knee, improve range of motion, and enhance balance and coordination. This helps them regain normal knee kinematics and movement over time.

What You Can Do at Home

Following intensive professional care, several self-care measures can complement your PCL injury recovery:

• Avoid harmful activities: Refrain from activities that put stress on the knee, such as running, jumping, or kneeling.
• Take pain relievers: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation. Always follow the recommended dosage.
• Maintain a healthy weight: Excess weight can put additional strain on the knee joint.
• Use assistive devices: Crutches or a cane may be helpful during the initial stages of recovery to reduce weight-bearing on the injured knee.
• Elevate your leg: Whenever possible, elevate your leg above heart level to reduce swelling.
• Wear a knee brace: A knee brace can provide additional support and stability during the healing process.

Finally, consult with your healthcare provider before starting any new treatment or activity.

How Can I Prevent PCL Injuries?

Strengthening the muscles around your knee, improving flexibility, and wearing appropriate protective gear can significantly reduce your risk of suffering a PCL injury. Engaging in regular exercise that focuses on lower body strength and balance also helps.

Conclusion

To recover from a PCL injury, dedicate some time to fully understanding your condition and the suitable treatment. Most individuals can restore their knee’s normal function with physical therapy, with or without surgical interventions. Always keep your doctor and physiotherapist's guidance and avoid to a high regard. Rushing the recovery process can only cause complications.

This information provides a general overview and should not replace professional medical advice. Always consult with a healthcare provider for an accurate diagnosis and personalised treatment plan.