Anatomy & Function

The posterior cruciate ligament (PCL) is the strongest ligament of the knee joint and is therefore less frequently injured. While the anterior cruciate ligament(ACL) is injured more often than the posterior cruciate ligament, statistics show us that more than 20% of reported knee injuries are due to a torn anterior cruciate ligament. Moreover, a posterior cruciate ligament injury is often overlooked and not diagnosed. It is one of several ligaments that connect the thigh bone (femur) to the shin bone (tibia). The posterior cruciate ligament stabilises the knee joint together with the other ligaments. Its course prevents the tibia from sliding posteriorly (backwards) in relation to the femur. In addition, together with the other ligaments, it restricts rotation in the knee joint.

shutterstock 176343236 PCL

Symptoms & Complaints

In most cases, external force is the cause (heavy blow or kick, accident) of an injury. A posterior cruciate ligament injury is usually a severe injury and is often associated with additional injuries.

Signs of a posterior cruciate ligament tear can be:

  • Effusion formation in the knee joint immediately, also possible with a delay
  • Knee pain
  • Inhibition of stretching and bending - Impairment of mobility
  • Reduction of the load capacity
  • Knee pain acute or insidious, sometimes latent
  • Swellings

Causes

In contrast to the anterior cruciate ligament rupture, a posterior cruciate ligament rupture occurs only rarely. The cause of a posterior cruciate ligament rupture is exceeding the maximum stretching possibilities. Such an excess is usually caused by external force. If there is a violent blow to the lower leg from the front while the knee is bent, the posterior cruciate ligament can tear. A typical injury is when the lower leg hits the dashboard of a car. A posterior cruciate ligament rupture rarely occurs in isolation, so other structures of the knee are usually affected as well. Therefore, the injuries in a posterior cruciate ligament rupture can be significantly more complex than in an anterior cruciate ligament rupture.

Diagnosis

More information will follow shortly.

Treatment

Conservative therapy

The acute posterior cruciate ligament injury often has a good spontaneous healing potential. Therefore, a conservative therapy attempt is justified. Here, the knee is immobilised for 6 weeks in special splints or moved with a movement-limited splint. These splints prevent the lower leg from sliding away when lying down and moving backwards.

The following therapies are possible:

  • Drug treatment: Drug treatment aims to relieve the pain or make it disappear completely.
  • Physiotherapy: Physiotherapy - special exercises to strengthen the muscles and mobilise them.
  • Physical measures: e.g. electrotherapy , cold treatment
  • Aids: e.g. walkingaids, knee supports, orthoses

Operation

If there is no improvement of the pain within the framework of the conservative treatment and if there is still a restriction of movement and load with signs of instability (Giving Way signs), surgical stabilisation is recommended. All surgical procedures can usually be performed arthroscopically, minimally invasive, by means of arthroscopy.

Reconstruction of the posterior cruciate ligament rupture

Posterior cruciate ligament rupture is treated with two tendons taken from the inner side of the thigh. (semitendinosus and gracilis tendon). After preparation of the graft, the transplantation is done arthroscopically after drilling the holes in the upper and lower leg. As much of the old posterior cruciate ligament as possible should be preserved. The fixation is done on the upper leg side with the Tight-Rope System (tilt anchor), on the lower leg with a dissolvable bio-screw.

Reconstruction of the posterior cruciate ligament rupture with posterolateral stabilisation

If an injury or loosening of the external ligament apparatus is present at the same time, the additional stabilisation of the external ligament structures should also be performed for posterior cruciate ligament reconstruction. The procedure can also be performed minimally invasively via two small skin incisions on the outside. One skin incision is over the head of the fibula, through which a small drill channel is also created. The other skin incision is on the outside above the knee joint. The tendon graft (gracilis tendon is often sufficient) is then pulled through the small drill channel in the fibula and both ends are pulled into the channel on the thigh bone and fastened there with a self-dissolving screw (bioresorbable screws).

Everything at a glance
  • Operating time: 60-75 min.
  • Possible anaesthesia: general or spinal
  • Hospital stay: outpatient and inpatient
  • Fit for work: 2-12 weeks
  • return to sports (RTS): 8-12 months

Our recommendation for posterior cruciate ligament reconstruction:

  • in athletes with a complete posterior cruciate ligament rupture who play high-impact sports such as football, rugby, handball, volleyball, basketball, tennis, dancing and also intensive aerobics.
  • In the case of subjectively complained instability with the so-called giving-way phenomenon, even after conservative treatment.
  • In the case of repeated effusions and swellings, which undoubtedly show instability as the primary cause of the complaints.
  • for concomitant injuries such as tearing of the meniscus, cartilage damage and also retropatellar knee pain, etc.
  • In the case of concomitant injuries of the periphery such as capsule-ligament injuries (e.g. anterolateral ligament, posterolateral instability, higher-grade inner-external ligament injuries, etc.).

Aftercare

More information will follow shortly.

FAQs

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dr tarek schlehuber
  • Specialist for orthopedics and trauma surgery in Freiburg
  • Leitender Arzt Sportorthopädie Loretto Krankenhaus

  • Certified knee surgeon of the DKG
  • Certified arthroscopist of the AGA
  • Sports doctor of the GOTS
  • Manual medicine / chiropractic
  • Team doctor Bahlinger SC / Cooperation doctor EHC
dr dan potthoff
  • Specialist in orthopedics and trauma surgery
  • Schulter- und Kniechirurgie

  • Artificial joint replacement of knee and hip joints
  • Cartilage surgery
  • Arthroscopic surgery
  • Joint wear and tear (arthrosis), sports injuries
  • Conservative orthopaedics