Suppose you’ve torn two or more of the four important knee ligaments (i.e. the anterior cruciate ligament, posterior cruciate ligament, the posteromedial corner- which the medial collateral ligament is a part of, or the posterolateral corner). In that case, you’re considered to have had a multiligament knee injury.

Posterior Cruciate Ligament Tears

The PCL (Posterior Cruciate Ligament) is one of the four main ligaments in your knee joint, and it’s located in the back of your knee. The PCL’s job is to keep your shin bone (tibia) from moving too far backward relative to your thigh bone (femur). It also acts to limit rotation when your knee is in a flexed position.

How do PCL tears happen, and what do they feel like?

The PCL is the knee’s strongest ligament, which requires considerable force to tear. Tears usually happen when you get a direct blow to the front of your knee while it’s bent, for instance, during a car crash, when the knee strikes the dashboard, or a hard tackle in football or rugby. Some people tear their PCL when they jump and then land awkwardly on a very bent knee.

Most PCL tears occur with other ligament injuries- and it’s uncommon to have an isolated tear. Sometimes, the PCL may also be torn during a knee dislocation.

If you have a PCL tear, you might experience:

  • Pain and swelling in the knee- sometimes felt at the back of the knee. The pain may not be severe.
  • Discomfort around the back of the knee when kneeling.
  • An uncomfortable feeling in your knee when walking downstairs or an incline.

MRI imaging is the gold standard test to confirm a PCL tear, and it will determine if any other structures are affected in the knee. It will also determine the severity of the PCL tear. However, if the PCL tear is chronic, the MRI scan may be normal as the PCL often heals, but if not braced appropriately early, it will heal in the wrong position (stretched) and will not function properly.

A Grade 1 PCL ligament tear means there is a tear in the ligament, but the ligament doesn’t feel lax.

A Grade 2 tear means there’s a partial tear with some degree of laxity.

A Grade 3 PCL tear means the ligament is completely torn, and the knee is fundamentally unstable.

What is the treatment for a PCL tear?

In many cases, isolated PCL tears can be treated without surgery and with plenty of physiotherapy to rehabilitate. Unlike the ACL ligament, the PCL has some healing capabilities, particularly if the tear is minor.

If you’ve damaged other ligaments in your knee, such as the ACL, MCL, or LCL, in addition to your PCL, you will likely need surgery to regain your knee stability. Surgery is also likely if you have torn a meniscus in addition to the PCL.

If you’ve tried non-surgical treatments, but your knee still feels unstable, or you’re having trouble with everyday activities, it may be time to consider surgery.

Sometimes, it is possible to repair the PCL ligament if it is torn at its proximal (femur end) attachment. Sometimes the PCL is torn away with a plug of bone from its distal (tibial) end, and it may be possible to reposition the ligament and screw it back into place. Midsubstance tears don’t tend to repair well, so reconstruction may be needed.

How long does it take to recover from PCL reconstruction surgery?

I recommend that if you have a desk-based job, you’ll need to take a couple off weeks off work, but if your work is more manual, you may need 2-3 months. If you’ve had an isolated PCL repair or reconstruction, you can fully weight-bear immediately, but if I’ve needed to repair other structures, you may be asked to be touch-weight-bearing or partially weight-bearing for a while. Returning to sport takes at least 12 months and longer if you’ve had more than one ligament repaired.

PCL reconstruction surgery

Most cases of a torn PCL occur with injury to other structures in the knee, and reconstruction of the PCL takes place along with surgery to the other structures. Because more than one ligament may need reconstruction, the PCL is reconstructed with an allograft. An allograft is ligament tissue from a deceased donor, and it’s carefully sterilised and processed so that all that remains is a collagen scaffold. No cellular material is left behind, so your body’s immune system won’t reject it.

During PCL reconstruction (which is a day-case, keyhole procedure), the remnants of the original (native) PCL are removed arthroscopically. A tunnel is created in the femur and the tibia to receive the allograft. The graft is fixed in place with a metal screw (because it’s strong, inert, and we can visualise it on an X-ray). I no longer routinely use bioabsorbable screws because, in some patients, they have been found to cause pain, foreign body reactions, and joint swelling.

How long does it take to recover from PCL reconstruction surgery?

I recommend that if you have a desk-based job, you’ll need to take a couple of weeks of work, but if your work is more manual, you may need 2-3 months. If you’ve had an isolated PCL repair or reconstruction, you can fully weight-bear immediately, but if I’ve needed to repair other structures, you may be asked to be touch-weight-bearing or partially weight-bearing for a while. Returning to sport takes at least 12 months and longer if you’ve had more than one ligament repaired.

Posterolateral Corner injuries

The Posterolateral Corner of the knee is an area that is commonly injured when ACL or PCL tears occur, and only around a quarter of posterolateral corner injuries occur in isolation. The posterolateral corner is a complex web of structures that provide stability in that area of the knee, helping to control the tibia’s rotation and backwards movement and prevent excess outwards bowing (varus movement) of the knee.

It has many structures, including the Lateral Collateral Ligament, the Popliteus Tendon, the Popliteofibular Ligament and the Lateral Capsule.

It’s important that injury to the Posterolateral Corner is spotted and repaired during PCL or ACL reconstruction because, if missed, it can potentially lead to the failure of the other reconstructed ligaments.

Book an appointment

Contact the clinic today on 0115 9662 174 (Circle The Park Hospital) or 0115 937 7801 (Spire Nottingham Hospital)

Schedule a consultation to discuss your treatment options and find the best solution for your knee pain.