PCL Reconstruction

A good candidate for PCL reconstruction generally includes individuals who have experienced a PCL tear and are having significant symptoms like knee instability, pain, or difficulty in performing their normal activities. This may include athletes who need to maintain an active lifestyle or individuals whose job requires heavy manual labor or extensive use of the knee.

However, not every PCL tear requires surgical intervention. Some can be treated with non-surgical treatments like physical therapy and bracing. Deciding whether to undergo surgery involves a discussion with knee surgeon, Dr. Ben Mayo.

PCL reconstruction surgery is usually performed arthroscopically, a minimally invasive surgical technique. Here are the typical steps: The procedure starts with the administration of general anesthesia. Your knee surgeon Dr. Mayo will then prepare a graft to replace your torn PCL. This graft is usually an autograft (taken from another part of your body), often from the hamstring tendon. Small incisions are then made around your knee and inserts an arthroscope (a small camera) to visualize the inside of the knee joint. The damaged PCL is removed carefully, and tunnels are drilled into your femur and tibia. The graft is then threaded through these tunnels in the same position as your original PCL. The graft is then secured with screws or other fixation devices to hold it in place while healing occurs.

Recovery from PCL reconstruction varies widely. Generally, patients can return to light activities or desk work within a few weeks post-surgery. However, for physically demanding jobs or sports, full recovery and return can take between six to twelve months. This period allows for the graft to fully integrate and the knee to regain strength and stability.

Immediately after surgery, you’ll likely have your knee bandaged and immobilized with a brace to protect the graft. You may need crutches to help with mobility while keeping weight off the knee. Pain is expected and will be managed with prescribed pain medications.

Physical therapy plays a crucial role in recovery after PCL reconstruction. It is critical to allow the graft to heal so you will not be allowed to bend your knee for one month after surgery.

• Early Stage: Goals are to control swelling, gradually increase weight-bearing, and allow the graft to heal. You’ll learn to walk with crutches and start gentle exercises. Near the end of this you will begin gentle range of motion.
• Middle Stage: As healing progresses, you’ll start more advanced strengthening exercises, and your therapist may introduce low-impact cardio activities like cycling.
• Late Stage: The final stage involves sports-specific training or activities related to your work to prepare you for a return to your usual level of activity.

Like all surgeries, PCL reconstruction carries some risks, including:

• Infection: Occurs in less than 1% of patients. You are given antibiotics before surgery to minimize this risk.
• Blood clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) are rare but can occur. You will take aspirin daily for one month to reduce this risk.
• Graft failure: The new ligament may not heal properly, leading to recurrent instability.
• Nerve or blood vessel damage: This is very rare but can result in numbness or weakness in the leg.

If left untreated, a torn PCL can lead to:

• Increased instability: You may experience frequent episodes of the knee “giving way,” which can result in falls and injuries.
• Further knee damage: The instability may lead to damage to other structures in the knee, leading to early arthritis.
• Limited function: Without surgery, you may be unable to return to your usual physical activities, including sports.