PCL Tear

PCL tears typically occur due to a direct blow to the front of the knee while it’s bent, such as in a car accident (known as a “dashboard injury”) or during a fall with a bent knee. PCL tears can also happen in sports when an athlete falls on a bent knee with their foot pointed down.

When a PCL tear happens acutely, you might feel pain and notice immediate swelling in the knee. The knee might feel unstable or like it’s going to give way when you try to put weight on it.

Long-term symptoms of a PCL tear might include:

• Persistent knee pain
• Difficulty walking or bearing weight on the affected leg
• A wobbly sensation in the knee
• Rapid swelling and stiffness in the knee

PCL tears are categorized into three grades based on severity, and how loose the knee is:

• Grade I: The PCL has a slight tear, but the knee joint is still stable. The tibia sits close to where it normally should..
• Grade II: The PCL is partially torn and the knee joint is mildly unstable. The tibia will sit slightly farther back than it would in an uninjured knee.
• Grade III: The PCL is completely torn and the knee joint is unstable. The tibia will sit behind the femur bone when the knee is bent. Usually, other structures will be injured if this is the case.

Unlike some other ligament injuries, PCL tears can sometimes heal without surgical intervention. However, this is largely dependent on the severity of the tear, and the patient’s activity level and functional demands.

A PCL tear is diagnosed through a combination of a physical examination and imaging tests. During the physical exam, the posterior drawer test will be performed to check for instability. Imaging tests, such as an MRI, can help confirm the diagnosis and assess the severity of the injury.

Non-surgical treatment options for PCL tears include physical therapy to improve strength and stability, and bracing to support the knee and prevent further injury. Surgical treatment, typically arthroscopic, is considered for high-grade tears, or when there are additional injuries to other knee ligaments.

Surgery is typically recommended for athletes or highly active individuals who have a high-grade PCL tear, or when other knee ligaments are also injured. Surgery should ideally be performed within a few weeks of the injury to achieve optimal results.

During PCL reconstruction surgery, a graft (usually from the patient’s own body or a donor) is used to replace the torn ligament. The graft is inserted using small instruments and a camera, and secured in place with screws or other fixation devices.

Recovery from PCL tear surgery often includes a period of immobilization, followed by a structured physical therapy program to restore strength, flexibility, and function to the knee.

Early phase recovery focuses on controlling pain and swelling, and gradually regaining range of motion. Later, physical therapy will focus on strengthening exercises and gradually returning to normal activities. Recovery time varies between individuals, but generally, most people can expect to return to light activity within 3 months and more strenuous activity within 6-9 months following surgery.