PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (2022)

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Written By:Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by:KPE Medical Review Board

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (1)

A PCL injury occurs when the posterior cruciate ligament of the knee gets overstretched and tears. Diagnosing PCL injuries is difficult and tears are frequently missed.

The posterior cruciate ligament is one of the main stabilizing ligaments of the knee.

PCL injuries most commonly occurs when there is a sudden force through the top of the shin bone, when the knee hyperextends (bends too far back) or occasionally from a twisting injury. PCL injuries are much less common than ACL injuries.

Here, we will look at the role of the posterior cruciate ligament, how it gets damaged and the symptoms, diagnosis and treatment options for a PCL injury.

What is the PCL?

The posterior cruciate ligament is one of a pair of ligaments, along with the anterior cruciate ligament, that sit in the middle of the knee joint. They join the femur to the tibia (thigh bone to shin bone) and control the stability of the knee.

(Video) Posterior Cruciate Ligament (PCL) Injuries

The PCL is the stronger of the two cruciate ligaments, and as a result is much less commonly damaged than the ACL.

The job of the posterior cruciate ligament is to stop the tibia (shin) from moving back too far in relation to the femur (thigh).

PCL Injury Mechanism

What causes a PCL injury? A posterior cruciate ligament injury happens when a powerful force goes through the top of the tibia, pushing it backwards and thus stretching the posterior cruciate ligament.

PCL injuries are usually caused by:

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (2)

  • Car Accident: Dashboard injuries, where the knee is bent and the shin hits the car dashboard pushing the knee into hyperflexion is the most common cause of PCL tears
  • Fall:Falling onto a bent knee with the foot pointing downwards is the most common sporting PCL injury
  • Sporting Tackle:sometimes the posterior cruciate ligament can be injured during an awkward tackle when the knee is bent
  • Hyperextension:the posterior cruciate ligament can also be damaged by the knee bending too far backwards

PCL Injury Symptoms

The most common PCL injury symptoms include:

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (3)

  • Pain:pain from a pcl tear is usually mild to moderate and may affect how you walk. Squatting is usually painful, particularly at approximately ninety degrees of knee flexion. Resisted knee flexion typically causes pain
  • Swelling:in the knee is usually mild to moderate. It tends to come on rapidly in the first few hours after injury. There may also be mild, slow swelling of the calf due to a synovial tear where the fluids slowly seeps downwards into the calf
  • Instability:the knee may feel slightly unsteady or like it is going to give-way after a posterior cruciate ligament injury, but it is rare that it actually does collapse
  • Difficulty with Activities: most commonly running (especially the initial push-off phase), anything on a bent knee (e.g. stairs), lifting heavy objects and taking off your shoes. Walking may feel "wrong".

The symptoms of a PCL injury are sometimes quite mild, and as a result it often goes unnoticed. Lingering problems with the knee not feeling quite right are often what leads to a diagnosis.

Diagnosing a PCL Knee Injury

The doctor can usually diagnose a PCL injury from examining your knee to see if the shin bone moves back too far when the knee is bent.

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (4)

(Video) Posterior Cruciate Ligament (PCL) Injuries

In a resting position with the knee bent, there should be a continuous, flat line from the kneecap down the shin. You can see in the picture here that the top of the shin bone has dropped backwards behind the normal line, a classic sign of a posterior cruciate ligament tear.

An MRI may be done to confirm the diagnosis but with a chronic PCL injury, one that you’ve had for a long time, an MRI may appear normal, despite continuing laxity in the ligament.

An x-ray may be done if an avulsion fracture is suspected with your pcl tear – where the ligament has torn off from its attachment bringing a small fragment of bone with it.

One simple test you can do to self-diagnose a posterior cruciate ligament tear is to stand upright and bend your knee to around ninety degrees. If that causes pain, rest your leg down, draw your toes upwards as much as you can (dorsiflexion) and repeat the knee flexion keeping the toes pulled up. If the pain is significantly less, it indicates a PCL injury.

Grades of PCL Tear

With a posterior cruciate ligament injury, as with allligament injuries, there are three different grades of injury. The higher the grade of injury, the longer it will take to recover.

A pcl sprain can be classified as:

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (5)

Grade 1:Minor injury with less the 10% of the fibres being damaged
Grade 2:Moderate injury with more of the fibres being torn
Grade 3:Major injury with the entire ligament being torn, known as a rupture.

Sometimes, other structures may be damaged at the same time as the pcl, such as another knee ligament, cartilage tear or a kneeknee dislocation.

PCL Tear Treatment

So how long does it take to recover from a PCL tear? Most PCL knee injuries are grade 1 or 2 and will heal naturally without the need for surgery within a few weeks. With grade 3 injuries, surgery is often required and it can take months to make a full recovery.

With a grade 1 and 2 PCL injury, recovery usually takes 6-12 weeks. PCL tear treatment usually consists of:

(Video) Posterior Drawer Test | Posterior Cruciate Ligament (PCL) Injury Knee

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (6)

  • Knee Brace:your doctor may recommend wearing a knee brace initially to help stabilize the knee and prevent further damage. Find the right one for you in theknee bracesection
  • Regular Ice: the help reduce the swelling and discomfort. Find out how to safely and effectively use this in the ice treatment section
  • Compression: to reduce swelling such as tubigrip compression bandage
  • Exercises:physical therapy to regain the strength, particularly of the quadriceps, mobility and stability of the knee is vital to ensure a full recovery and to prevent any long-term instability which can lead to arthritis

People often ask if a completely torn PCL can heal on its own. Unfortunately the answer is no, but it may be possible to build up enough stability that you can live without a functioning posterior cruciate ligament without having it surgically repaired.

Posterior Cruciate Ligament Surgery

With more severe posterior cruciate ligament injuries, surgery may be required. This is usually advised if there are associated injuries e.g. damage to other ligaments or patellar dislocation, avulsion injuries, where a piece of bone has broken off, and chronic cases of long-term instability despite adequate rehabilitation.

PCL Injury: Posterior Cruciate Ligament Tear- Knee Pain Explained (7)

PCL surgery is usually carried out arthroscopically, keyhole surgery, and involves replacing the damaged ligament with a new one, known as a graft, usually fashioned from other tissue such as the patellar or hamstrings tendon.

If the pcl tendon is intact but has torn of part of the bone, it will simply be reattached with screws.

Surgery tends to be more successful when carried out soon after the PCL injury. Following surgery you will work on a rehab programme with a physical therapist and it can take 6-12 months to fully recover.

Ongoing Problems After PCL Tear

A PCL injury often goes undiagnosed as the symptoms tend to be fairly mild. If you are having ongoing problems with the stability of your knee, or it just doesn’t feel quite right, get it looked at by your doctor, you may have a pcl tear.

Page Last Updated: 10/14/21
Next Review Due: 10/14/23

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References

1. The Archives of Bone and Joint Surgery:Posterior Cruciate Ligament: Current Concepts Review. S. Pache, Z. Aman, M.Kennedy, G. Yoshinobu Nakama, G. Moatshe, C. Ziegler, R. LaPrade. January 2018

2. Current Reviews in Musculoskeletal Medicine:Nonoperative Treatment of PCL Injuries: Goals of Rehabilitation and the Natural History of Conservative Care. D. Wang, J.Graziano, R. Williams, K. Jones. June 2018

3. WebMD:Posterior Cruciate Ligament Injury. T. Wheeler. February 2018

FAQs

How painful is a torn PCL? ›

Unlike the “pop” and severe pain that may occur with a torn anterior cruciate ligament (ACL), an isolated PCL tear may simply cause swelling and mild pain in the knee. These symptoms subside over a few days or weeks. If you've torn the PCL and one or more other knee ligaments, symptoms might include: Severe swelling.

Where does your knee hurt with a torn PCL? ›

People who have injured the posterior cruciate ligament (PCL) of the knee often report a combination of the following symptoms: Sharp or dull pain around the back of the knee. This can occur immediately or develop in the hours or days after the injury.

What does a posterior cruciate ligament tear feel like? ›

The amount of discomfort, stiffness and swelling that follow a posterior cruciate ligament injury is not always substantial, and many PCL injuries are initially diagnosed as knee sprains. Patients will often have discomfort, especially in the back of the knee when bending it, and the knee may become swollen.

Is tearing your PCL worse than ACL? ›

The pain from an ACL tear usually will be more severe than that of a PCL tear. There also may be significant (or total) loss of range of motion of the knee. Swelling from an ACL tear tends to develop slowly, over the course of 24 hours.

Can u walk with a torn PCL? ›

If you have a PCL injury, you may need: Crutches to walk until the swelling and pain get better. A brace to support and stabilize your knee. Physical therapy to help improve joint motion and leg strength.

How long does a PCL tear take to heal without surgery? ›

Generally, for non-operative treatment, a PCL tear can take up to 6 months to recover. Sometimes, recovery can take longer as the knee takes time to get used to not having a PCL. In some cases, the forces on the kneecap or the medial compartment increase leading to early arthritis in these joints.

Can PCL tear heal itself? ›

PCL injuries are usually partial ligament tears, and typically heal on their own, without causing stability issues, so long as the knee is protected during healing, and there are no other knee joint injuries. However, PCL injuries can lead to osteoarthritis of the knee.

What are 2 special tests for a PCL injury? ›

To follow is the description of two functional tests, as-of-yet undescribed in the literature, that can be used as adjuncts for the diagnosis of a PCL injury: the Posterior Functional Drawer test (PFD), and the Proximal Tibial Percussion test (PTP).

Does PCL tear require surgery? ›

Many Grade I and grade II injuries will not require PCL surgery. Surgery is often recommended when there is a complete tear of the PCL, if there is also damage to surrounding ligaments, or if the knee has become dangerously unstable.

What does it mean when it hurts behind your knee? ›

Causes of pain behind the knee

your knee joint wearing down as you get older – for example, you may have osteoarthritis or rheumatoid arthritis. a knee injury (ligament injury or torn cartilage) a benign or cancerous growth (this is very rare) an infection (septic arthritis)

Can a grade 3 PCL tear heal without surgery? ›

Generally, surgery is only recommended for those who have grade III PCL tears, multiple ligament injuries (such as a PCL and ACL tear), and knee instability that has not responded to nonsurgical treatment.

How long is a PCL tear recovery? ›

The duration for a PCL injury also depends on the severity of the sprain, but typically full recovery is achieved between 4 to 12 months.

What is the most painful ligament to tear? ›

The quick answer is that the ACL (Anterior Cruciate Ligament) is most likely to be considered the worst ligament in the knee to tear.

What should you avoid with a PCL injury? ›

Avoid knee hyperextension. Limit leg strength exercises to no more than 70 degrees of knee flexion. PCL brace worn at all times.

What is the most serious knee injury? ›

Kneecap fractures are a common yet serious injury that usually requires immobilization or in some cases surgery to correct. Knee dislocations occur when the knee bones become out of place. This can occur after a major trauma such as a fall, car crash, or high-speed impact.

How long does a torn PCL take to heal? ›

The duration for a PCL injury also depends on the severity of the sprain, but typically full recovery is achieved between 4 to 12 months.

How long does PCL surgery take? ›

Doctors connect the PCL graft on either bone using screws or staples to rebuild the PCL. The average surgery takes around two hours. This is a minimally invasive operation. You'll likely go to an outpatient surgical center.

Does a Grade 2 PCL tear require surgery? ›

A partial PCL tear, grade I and II, are typically treated non-operatively with a long course of intensive physical therapy to strengthen the surrounding muscles controlling the knee. Complete PCL tears often require surgical treatment to regain knee stability.

How long does a Grade 2 PCL tear take to heal? ›

Recovery from posterior cruciate ligament (PCL) injury

Recovery from a PCL sprain or tear depends on the severity of the injury. Mild (Grade 1) sprains take ten days to two weeks to heal. Moderate (Grade 2) sprains take three to four weeks to fully recover.

Videos

1. ACL Injuries vs. PCL Injuries
(Lets Learn PT)
2. UOA On Demand: Posterior Cruciate Ligament (PCL) Injuries
(University Orthopaedic Associates)
3. PCL injury of the knee: Mechanism of injury and treatment options
(Dr. David Geier)
4. Knee injury ,Injuries - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
5. Posterior Drawer Test, PCL Injury - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
6. Posterior Cruciate Ligament (PCL) tear
(First Look MRI)

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