What is PCL Tear or PCL Injury ?
Posterior cruciate ligament is one of the four ligaments located inside the knee joint. PCL is strongest ligament in the group, which starts from back of tibia backside to front of femur. Ligaments are made of strong tissue bands that connect bones i.e. femur and tibia. ACL along with PCL form an “X” at the middle region of knee.
The main function of PCL is to provide stability to the knee and even it prevents the knee from bending back. It is also crucial in supporting person’s body weight during any activity. PCL is somewhat similar to ACL, but it is stronger as well as larger than ACL.
PCL may incur injury, tear, strain or sprain due to hyperextension, direct blow to kneecap and sudden twisting. It is common sporting injury but least caused to individuals, when compared with other three ligament injuries i.e. ACL tear, MCL tear and LCL tear.
PCL is important part of knee, which resists the backward motion of the leg at knee joint. It is necessary for many important daily activities such as walking. 20% of knee injuries are PCL injuries. Often, PCL is accompanied with other ligament injuries and splitting a small part of underlying bone.
What are the Causes of PCL Tear?
Generally, powerful blow is required to tore or injure posterior cruciate ligament. Some of the common causes of PCL tear are:
- Powerful Blow: PCL is torn when knee in bending position receives massive blow such as hitting dashboard in car accident or falling on bent knee in American football.
- Hyperextension: When knee is extended beyond its limits or too far, then there is high probability of PCL injury.
- Twisting: Sudden and excessive valgus forces applied to knee when knee is bent. Such twisting of knee in abnormal position could lead to tear in PCL.
- High Intensity Sports: Individuals involved in sports like soccer, football, skiing, gymnastics, hockey and rugby often diagnosed with PCL tear. The reason is that these sports are high risk sports and requires lots of running, sprinting, jumping, kicking, pivoting, acceleration and deceleration, which makes them prone to PCL sprain on the field.
- Netball & Basketball: Since these sports require jumping higher or sprinting faster, Incorrect and improper landing techniques increases the risk of PCL injury to the knee.
- Overuse Injury: PCl injury is also caused due to repetitive micro-trauma over a period of time to the ligaments and bones. Training errors and improper techniques while playing certain sports are the leading causes of overuse injury.
- Collision: Colliding with opposite players, tackling ball on the field and falling awkwardly always leads to PCL tear.
- Sudden Pivoting: Players when suddenly change their direction while having their foot firmly planted on the ground often tear their ligaments specially PCL.
- Misstep: A clumsy and badly judged step while walking or running . can tear the ligament. While walking, knee bears all the weight of the body. So, any misjudgment will greatly increase the risk of injury to the knee.
- Severe Trauma: PCL tear is often caused due to severe and repetitive trauma such as acl inury, meniscus tear, knee dislocation and posterolateral rotator instability.
What are the Symptoms of PCL Injury?
The symptoms of PCL injuries are quite identical to ACL tear’s symptoms. However, commons signs are
- Sudden Pain inside the knee joint.
- Rapid onset of swelling along with tenderness at the point of injury.
- Decrease in range of motion
- Mild to moderate loss of function depending on the grade of injury.
- Audible pop sound at the time of injury.
- Stiffness in knee after prolonged period of inactivity or rest.
- Knee giving away sensation or knee instability.
- Knee will wobble while walking.
- Knee can’t be able to bear weight.
- Patients fear to trust their knees in severe cases.
Diagnosis of PCL Injury :
Doctors conduct through physical test like moving knee in various directions and ask medical history for better diagnosis. Posterior drawer test is also conducted, which is most reliable and trusted method of identifying any injury to PCL.
X-rays are beneficial in determining any injury to PCL and broken bone due to torn ligament. MRI are often useful for getting pictures of torn tissues and helps in accurate diagnosis of PCL tear.
Other ligament injuries and cartilage tear are often common with PCL injury. The injury is mild to severe and doctors have graded the injuries according to the severity of tear.
Types of PCL tear:
The severity of a PCL tear can vary greatly from partial tear to a complete rupture. PCL injury are classified into four grades. They are:
PCL Grade 1 Tear – Minor sprain or partial tear of PCL. The ligament is mildly stretched and the knee joint is still stable.
PCL Grade 2 Tear – Major sprain or incomplete tear of PCL. The ligament loosens and partially torn.
PCL Grade 3 Tear – Severe sprain and complete tear. Even, the knee joint becomes unstable and shaky.
PCL Grade 4 Tear – Complete rupture of ligament along with other ligament injuries.
Treatment of PCL Injury :
The treatment for PCL tear mainly depends on the grade of injury along with type of treatment i.e. surgical and non-surgical. The key to effective treatment is controlling pain, swelling and other symptoms as soon as possible. Some of the common treatment associated with PCL tear are:
- R.I.C.E.: This protocol is extremely effective during the early stages of injury. The acronym stands for protect, rest, ice, compress and elevate.
- Protect: Protect your knee from further injuries. Avoid aggravating activities that could deteriorate simple tear. Sometimes, individuals neglect simple tear and continue normal sporting activities, which results in complete rupture and other ligament injuries.
- Rest: Resting the knee joint is crucial aspect of treatment as it allows the pain to settle down and heal naturally.
- Ice: Applying ice packs to the point of injury is important step in this protocol, which will reduce swelling and pain. Apply for 15- 20 minutes, several times a day. Never ever apply ice directly to the injured area because it will damage the soft tissues.
- Compress: With the use of elastic bandage, compress the injured area to minimize and limit the swelling and tenderness. Don’t wear the bandage tightly and ensure your remove it couple of times a day.
- Elevate: Lift your leg above the heart’s level so that the leg stays in still position which will potentially makes speedy recovery.
- Knee Immobilizer: Doctors often recommend them for immobilization or resting the knee.
- Splinting: Splinting technique will help prevent from further injury and provide massive amount of relief and respite from poorly localized pain. Ready-made splints are quite useful in treatment of PCL tear.
- Knee Brace: Bracing will prevent further injuries and keeps the knee safely. They will stabilizes and support the knee. They are extremely effective in controlling sideways movement of knees and saves the knee from unusual movements.
- Crutches: Doctors often advise patients to use crutches while walking in order to keep off putting unnecessary weight on your injured knee while walking. It is advisable to use crutches until and unless you start to walk properly without limping.
- NSAIDs: Doctors prescribe NSAIDs very rarely in order to minimize the pain and swelling. We advise strictly to consult your doctor before diagnosing any type of medications.
- Physical Therapy & Rehabilitation: Consult a physical therapist because certain exercises will improve the strength in knee joint and muscles. The exercises will provide stability and flexibility to the knee. Some exercise to regain range of motion and proper knee joint functioning are: quad sets, seated quad sets, knee stabilization, straight leg raise, wall squat with a ball, step-up, and wobble board exercises, which are beneficial in treatment of PCL tear. These exercises improve and regain the balance and control of the knee joint.
- Heat treatment: It is also known as thermotherapy, which provide relief from pain , reduce stiffness in knee joint and promotes the healing process.
- Electrotherapy: It will assist in pain reduction with the help of energies associated with electrical, sound, light, magnetic, temperature. Some of the modalities are TENS and ultrasound.
- Soft Tissue Massage: Massage therapy is critical component of PCL tear rehabilitation program. They alleviates pain, increase relaxation and flow of blood.
- Hydrotherapy: Water is used to treat the injury where in special excise are performed in warm water pool. It is also called as hydropathy and water therapy. it will increase the extensibility in the soft tissues.
- Education: Learning proper sports technique and methods often prevents the athletes from suffering injuries. Even if suffering from any PCL tear, it is wise to get informed about the injury and avoid any aggravating activities in future that can trigger the injury and spoil their career.
- Activity Modification: It is advisable to change the lifestyle or modify regular activities because it will greatly improve the health and life. Warm-up properly and adequately before engaging in any high intensity sports.
- Surgery: Surgeons replace the torn PCL with healthy tissue rather than stitching. It is open surgery, which requires large incision in the knee. Surgery is very rare unless your PCL is completely ruptured or isolated. Sometimes, surgeons tie up the broken fragment of bone to its base. In some cases, they use small incisions with the use of anthroscope, a less invasive method.
Recovery Period for PCL Injury:
The recovery period depend on the grade of injury and type of treatment. If surgery is performed, then normally, it will take 6-12 months for complete recovery. For non-surgical treatments for minor tears, it will take couple of weeks to couple of months time. If the PCL tear is followed with ACL tear or meniscus injury, then it will slow down the recovery time.
Conclusion – PCL Injury:
The outlook is good and patients starts performing daily activities once they are completely recovered from PCL tear. Learn proper tactics and techniques under the supervision of experienced and qualified coaches. Regularly exercise to strengthen the muscles around the knee joint. Never increase the level of your activity suddenly. Wear comfortable and branded shoes that are specific to your type of sport.