PCL Reconstruction - Posterior Cruciate Ligament

What is PCL injury?

The PCL, one of the key ligaments in the knee joint, plays a crucial role in stabilizing the tibia (leg bone) on the femur (thigh bone). It originates from the lateral side of the medial condyle of the femur and attaches to the back of the tibial plateau. Its primary function is to prevent backward movement of the tibia relative to the femur, as well as to withstand varus, valgus, and external rotation forces. The PCL is thicker and stronger than the ACL, making it less susceptible to injury. Compared to ACL injuries, PCL injuries are less frequent, with an incidence ranging from 3 to 40 in Indian populations. Males are more likely than females to experience PCL injuries at a ratio of 2:1. PCL tears commonly occur alongside other ligament injuries; isolated PCL tears are uncommon occurrences.

How does PCL injury occur?

The PCL can be injured by strong forces pushing the proximal tibia of a bent knee forward, such as in dashboard injuries or falling onto a bent knee. Common sports associated with PCL injuries include football, skiing, soccer, and baseball. Less frequently, the PCL can be damaged during rotational hyperextension of the knee. Research from 2003 identified car accidents and sports as the main causes of PCL injuries. Dashboard injuries and falls onto a flexed knee with the foot pointed down are the most common ways the PCL gets injured. Athletes often experience isolated PCL injuries due to excessive bending of the knee. Injuries can also occur from landing poorly after a jump or making sudden movements in different directions.

What are types or grades of PCL injury?

PCL injury may present with different grades or severity.

• Grade – 1: Mild sprain in which the knee is stable and function will be normal.
• Grade – 2: Partial tear, with a feeling of instability.
• Grade – 3: Complete tear or bony avulsion from tibia at the insertion point, causing instability and inability to bear weight or walk.

What are symptoms & signs of PCL injury?

Severe trauma can lead to PCL injuries. Patients typically experience sudden pain, swelling, and instability. It is important to gather a comprehensive history, including details about motor vehicle accidents and dashboard injuries where the knee was fully flexed. Some patients may hear a popping sound similar to an ACL injury, while others may not. In acute cases, there may be instability, but the patient can still walk and bear weight. Chronic PCL tears may cause discomfort, instability, and pain at the back of the knee when bearing weight with a slightly bent knee position (such as climbing stairs or squatting).

How to diagnose PCL injury?

The orthopedic doctor will conduct a thorough examination of the patient, including physical and clinical tests such as the posterior drawer test, posterior Lachman test, posterior sag test, and other relevant tests to identify PCL tears. Diagnostic procedures like X-rays will be performed to rule out fractures or avulsions, with a CT scan ordered if necessary. However, MRI remains the primary diagnostic tool for confirming ligamentous injuries and providing a more precise assessment of the injury. X-rays will include various views of the knee to assess for any associated fractures or bony involvement. MRI is considered the gold standard for evaluating PCL injuries and can also detect other ligament or meniscus injuries.

What is the treatment of PCL tear?

The main factor in considering the treatment of PCL tear depends on whether it is acute or chronic, any associated injury, the presence of bony avulsion of the PCL, and any displacement of a bony fracture. Non-operative treatment is primary for PCL tears in type 1 and 2 acute injuries, as there are good outcomes and a return to sports is possible. Conservative treatment includes ice packs, rest, braces, NSAIDs, immobilization for 3 to 4 weeks, and subsequent physiotherapy for acute injuries. In type 3 tears, conservative management can be done, but chances of instability are higher and healing may be less effective; long-term bracing may be necessary.

Surgical intervention is indicated for acute injuries with significant tibial translation (>12 mm), instability, bony avulsion with displacement exceeding 4 mm, associated injuries of the knee menisci or other ligaments, and chronic PCL tears. Surgical options include arthroscopic repair of PCL in avulsion cases or reconstruction with grafts from hamstrings or quadriceps. Open techniques may also be used for avulsion injuries, followed by physiotherapy for optimal recovery. Return to sports can occur within 8 to 9 months post-surgery.

PCL reconstruction surgery is crucial for individuals dealing with knee stability issues and experiencing chronic pain due to PCL injury. If you are looking for the best PCL Reconstruction Surgeon in Delhi, look no further than Dr. Vishwadeep Sharma. Dr. Sharma has years of specialized training and experience in knee surgery, earning a reputation for his precision and skill in performing PCL reconstruction surgeries. Patients trust him for his technical proficiency and compassionate approach to care.

Dr. Vishwadeep Sharma's commitment to advancements in orthopedic surgery ensures that patients receive innovative treatments. His dedication to achieving optimal outcomes sets him apart as a top choice for PCL reconstruction surgery in Delhi. With Dr. Sharma, patients can rest assured they are in capable hands, receiving personalized care tailored to their unique needs.

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