Orthopaedic Surgeon | Foot and Ankle

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PCL Injury

PCL – Function

The Posterior cruciate ligament (PCL) is a rarely injured ligament that is positioned at the back of the knee. The primary function of the PCL is to limit backward movement of the tibia (‘shin bone’) on the femur (‘Thigh bone’).

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PCL Injury – Mechanism

The most common mechanism for a PCL injury is a direct blow to the tibia with the knee in a flexed position. This can occur during a sporting collision, or can be seen as a result of a “Dashboard” injury, during a motor vehicle accident. A PCL injury can occur in isolation, or can be part of a more complex injury involving multiple knee structures.

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PCL Injury – Making the diagnosis

Patients with PCL injuries often experience knee pain, stiffness, and instability with difficulty walking. Your description of the injury is important, and a detailed physical examination will be performed. There are several examination findings that point towards a PCL injury, including a ‘sag’ in the position that the tibia sits in relation to the femur. Laxity of the ligament is also noted. The diagnosis is confirmed with plain xrays and an MRI scan. The plain xrays will assess for a bony avulsion (‘chip of bone’) that can occur on the back of the tibia. An MRI scan will give a detailed assessment of any PCL tear, as well confirming the integrity of other knee structures, such as the meniscus and other knee ligaments.

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PCL tears are graded I to III, with III being the most severe. This system is based on the degree of backwards tibial motion that can be reproduced.

Grade I – Partial Tear

Grade II – Isolated complete Tear

Grade III – Often associated with other ligamentous injury


PCL Injury – Making the diagnosis

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The majority of isolated PCL injuries can be managed non-operatively. In the acute setting this involves a period of rest, ice, compression, and bracing. A PCL specific extension brace is used to maintain the tibia in correct alignment under the femur, while healing occurs. A period of time on crutches, with avoidance of weight bearing may be required.


PCL Injury – When to operate

Surgical reconstruction by an orthopaedic surgeon, involves arthroscopically placing a ‘graft’ in place of the torn PCL. There are two main scenarios where surgical reconstruction is considered.


Failed conservative management of an isolated grade 3 PCL tear

When a patient experiences ongoing knee instability despite appropriate rehabilitation.


Multi-ligamentous Knee Injury

This represents a serious knee injury, and a tailored surgical approach is required.

Click here to learn more about the surgical technique for a PCL ‘reconstruction’

Dr. Mike Smith and his staff can be contacted by one of the methods outlined below. For any acute injuries, we will ensure that you are seen as soon as possible. We look forward to welcoming you soon.

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