PCL (Posterior Cruciate Ligament) Reconstruction
PCL is an acronym for the ‘posterior cruciate ligament’. It is an important ligament that is found in the centre of the knee, and it helps to maintain knee stability by preventing backward movements of the tibia (or shin bone) relative to the femur (or thigh bone). Injuries to the PCL are less common than those to the ACL (or anterior cruciate ligament). They usually occur due to direct, contact injuries to the knee during road traffic accidents or sporting activities.
The diagnosis of a PCL injury is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as other knee ligament tears, meniscal tears and cartilage injuries.
Most patients with isolated tears of the PCL may be treated non-surgically with a course of rehabilitation. However, patients with severe tears, those with symptoms of recurrent knee instability and those with additional ligament and meniscal tears are candidates for surgical treatment.
Surgical treatment involves PCL reconstruction. This surgery is usually performed under general anaesthesia, using minimally invasive arthroscopic (keyhole) techniques. The surgery essentially involves replacing the torn PCL with a new PCL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new PCL graft is secured within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft). At the same time, concomitant injuries to the other ligaments, menisci or cartilage may be addressed. An overnight stay in hospital is usually required after PCL reconstruction and 4-6 weeks of crutch-assisted ambulation may be advised.
The rehabilitation process after the surgery is supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last 9-12 months following the PCL reconstruction procedure. The success rate of PCL reconstruction surgery has been reported to be about 80-90%. The complications of this procedure include PCL graft injury, knee stiffness and infection.
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