Surgical Information

Posterior Cruciate Ligament (PCL) Reconstruction

What is PCL reconstruction?

PCL reconstruction is surgery to rebuild a torn posterior cruciate ligament (PCL) in the knee.

PCL tears occur due to trauma, such as automobile accidents, or falling on the knee when bent. They are common sports-related injuries and usually cause severe pain and disability.

Most PCL reconstruction is performed using knee arthroscopy. In this minimally invasive procedure, the surgeon makes several small incisions around the knee joint and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the knee. Tiny instruments are used to remove the damaged ligament and replace it with a graft. Tunnels are drilled into your femur (thighbone) and tibia (shinbone) to accurately position the graft, which is then anchored with screws or other fixation devices. PCL reconstruction surgery uses an autograft (tissue from your body) or an allograft (tissue from a cadaver) to replace the ligament.

Anatomy

The PCL is one of the major ligaments of the knee. It runs diagonally in the middle of the knee and connects the back of the femur (thighbone) to the front of the tibia (shinbone). Along with the anterior cruciate ligament (ACL), the PCL controls the knee's back-and-forth and rotational motion. The PCL is larger and stronger than the ACL. It is composed of two distinct bundles and is injured less often. Many times, a PCL injury occurs with injuries to other structures in the knee such as cartilage, ligaments and bone.

When is surgery recommended?

Treatment of a PCL tear depends on the severity of the injury. Not all PCL tears require surgery.

Initial treatment focuses on pain control, restoring range of motion and preventing further injury. It is important to regain motion in the knee as soon as possible to aid in recovery.

The decision for operative or non-operative treatment depends on several factors including a patient's age, activity level, symptoms and expectations. For older, sedentary patients with a relatively stable knee and little desire to return to high-level sports or fitness routines, non-operative rehabilitation and activity modification may be sufficient. For active patients of almost all ages – especially young athletes – reconstruction of a PCL tear is highly recommended. Restoring the native bundles of the PCL is necessary to stabilize the knee. Stable knees are critical for safely returning to sports and preventing re-injury or additional injury. PCL reconstruction can also help to minimize the chance of knee arthritis or instability later in life. Therefore, anatomic double bundle PCL reconstruction is often recommend for patients with complete PCL injuries.

What is the recovery time?

Return to daily and sports activities varies depending on the surgery and your surgeon. An appropriate physical therapy program to regain knee strength and range of motion is considered critical for the success of PCL reconstruction. Usually, return to work is restricted for several weeks to months, depending on the type of job you do. Return to sporting activity is typically restricted for at least six months.