The posterior cruciate ligament (PCL) may be torn alone or in conjunction with other knee ligaments. If the PCL alone is injured, nonsurgical treatment may be all that is necessary. However, if the PCL is severely injured or injured in combination with other structures of the knee, surgery may be required in order to reconstruct the PCL ligament.
Nonsurgical Treatment for Torn PCLs
Initial treatment for a PCL injury focuses on decreasing pain and swelling in the knee. Some nonsurgical options that may be suggested by your orthopedic specialist include:
- The RICE method. Rest, ice, gentle compression, and elevation.
- Mild pain medications. Medicines such as acetaminophen can help relieve pain and swelling.
- Immobilization. In the beginning, you may need to use a long-leg brace to prevent your knee from moving and crutches to keep you from putting weight on your leg. Most patients, however, are given the okay to put a normal amount of weight down while walking.
- Physical therapy. Most patients receive physical therapy treatments after a PCL injury. Less severe PCL tears are usually treated with a progressive rehabilitation program. Therapists treat swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation. Your therapist will also incorporate exercises to help you increase strength and improve mobility.
- PRP therapy. Platelet Rich Plasma (PRP) Therapy is a combination of biology and biochemistry used to regenerate bone and soft tissue like ligaments.
Patients intending to return to high-demand activities after physical therapy may require a functional knee brace before returning to these activities. These braces are designed to enforce knee stability when the PCL doesn't function properly. They help keep the knee from giving way during moderate activity, but they can give a false sense of security and won't always protect the knee during sports that require heavy cutting, jumping, or pivoting.
Functional braces are not the type of braces you can buy at the drugstore. In most cases, your brace will need to be custom ordered to ensure a proper fit. Your SROSM orthopedic doctor will help determine the best brace for you and obtained a custom fit for your knee. Most orthopedists will recommend wearing a brace for at least one year after a surgical reconstruction. So even if you decide to have surgery, a brace is probably a good investment.
Reconstruction Surgery for a Torn PCL
If the PCL is the only ligament injured, patients can typically do well with rehabilitation and avoid surgery. However, if the PCL is severely injured or injured in combination with other structures of the knee, patients generally do better having surgery within a few weeks after the injury. Without reconstructive surgery, knee instability and joint degeneration often develop over time.
PCL surgery involves completely removing the torn ligament and reconstructing the torn PCL using a minimally invasive arthroscopic technique. Incisions are usually still required around the knee, but the surgery doesn't require the surgeon to open the joint. The arthroscope is used to perform the work needed on the inside of the knee joint. A new PCL is made by using tendon graft obtained from either the patient (autograft) or a cadaver (allograft).
Most PCL surgeries are now done on an outpatient basis, and most patients stay either one night in the hospital, or they go home the same day as the surgery.
Rehabilitation After PCL Reconstruction Surgery
Rehabilitation plays a vital role in getting you back to your daily activities after surgery. Your SROSM surgeon will recommend a therapy program that will help you regain knee strength and motion. Our on-site physical therapists will guide you through all you need to do.
The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. Physical therapists will begin to focus on range of motion exercises within three weeks. They take care to avoid letting the tibia sag back under the femur, as this can put strain on the healing graft.
Rehabilitation methods your SROSM physical therapist may recommend could include:
- Using a continuous passive motion (CPM) machine immediately after your operation to help the knee begin to move and to alleviate joint stiffness. The machine straps to the leg and continuously bends and straightens the joint. This continuous motion is thought to reduce stiffness, ease pain, and keep extra scar tissue from forming inside the joint.
- Wearing a protective knee brace for up to six weeks after surgery.
- Using crutches to keep your knee safe and limiting how much weight you put on your knee while you’re up and walking. You may need to use crutches for 6 to 8 weeks.
- Strengthening exercises for the quadriceps muscle. Muscle stimulation and biofeedback, which both involve placing electrodes over the quadriceps muscle, may be needed at first to get the muscle going again and help retrain it. As the rehabilitation program evolves, more challenging exercises are chosen to safely advance the knee's strength and function.
When you get full knee movement, your knee isn't swelling, and your strength is improving, you'll be able to gradually get back to your work and sport activities. Your surgeon may prescribe the use of a functional brace if you are an athlete who intends to return quickly to their sport.
Ideally, you'll be able to resume your previous lifestyle activities. However, athletes are usually advised to wait at least six to nine months before returning to their sport. And most patients are encouraged to modify their activity choices.
Progressive rehabilitation programs can last anywhere from four to six months after surgery to ensure the best result from your PCL reconstruction. In the first six weeks following surgery, expect to see your physical therapist two to three times a week. If your surgery and rehabilitation go as planned, you may only need to do a home program and see your therapist every few weeks over the four to six month period.
You can learn more about PCL injuries and reconstruction by downloading our educational document A Patient’s Guide to Posterior Cruciate Ligament Injuries.