Posterior Cruciate Ligament (PCL) Injury

The posterior cruciate ligament (PCL) connects your upper leg to your lower leg. Even though your PCL is stronger and larger than your anterior cruciate ligament (ACL), it can still be injured. People with a PCL injury may have pain, swelling and other symptoms. Treatments include both non-surgical and surgical options.

What is a posterior cruciate ligament injury?

Your posterior cruciate ligament (PCL) runs along the back of your knee and connects your thighbone to the top of your lower leg bone. This ligament keeps your bones in place and helps your knee move smoothly. When the PCL is sprained or torn, it’s called a posterior cruciate ligament injury.

Who do posterior cruciate ligament injuries affect?

Posterior cruciate ligament injuries can happen to anyone, but they’re especially common among skiers and athletes who play baseball, football or soccer.

How common are posterior cruciate ligament injuries?

Posterior cruciate ligament injuries are far less common than ACL (anterior cruciate ligament) tears. In fact, PCL injuries make up less than 20% of all knee ligament injuries. Most commonly, PCL tears occur with other ligament injuries. Isolated PCL tears are even less common.

How does a posterior cruciate ligament injury affect my body?

A PCL injury can cause mild, moderate or severe damage. Healthcare providers rate posterior cruciate ligament injuries in four different categories:

• Grade I. A partial tear is present in the ligament.
• Grade II. There’s a partial tear and the ligament feels loose.
• Grade III. The ligament is completely torn and the knee is unstable.
• Grade IV. The PCL is injured and another knee ligament is damaged.

People with posterior cruciate ligament injuries may have short- or long-term symptoms. Typically, long-term symptoms occur when an injury slowly develops over time.

Can you walk with a PCL injury?

It depends. In mild cases, people may still be able to walk and their symptoms may be less noticeable. However, many people have difficulty walking after a PCL injury — especially if the damage is severe.

Do PCL tears hurt?

Generally, yes. Pain is one of the leading symptoms of a torn PCL. Discomfort may be mild or severe.

What happens if a child tears their PCL?

In most cases, pediatric PCL injuries can be treated with non-surgical methods. However, if your child’s PCL injury is severe, surgical options may be explored.

Symptoms and Causes

How do PCL injuries occur?

PCL injuries usually occur with severe knee trauma. You may develop a problem with your PCL if you:

• Fall onto a bent knee.
• Are hit hard on the front of your knee (think dashboard in a motor vehicle accident).
• Bend your knee too far backward.
• Dislocate your knee.
• Land improperly after a jump.

What are the symptoms of a posterior cruciate ligament injury?

People with PCL injuries may experience a wide range of symptoms, including:

• Pain that worsens over time.
• Swelling and inflammation.
• A feeling of instability in the knee.
• Stiffness.
• Difficulty walking.
• Trouble going down the stairs.

Diagnosis and Tests

How is a posterior cruciate ligament injury diagnosed?

Your healthcare provider will examine your knee, check your range of motion and ask about your symptoms. They may also request imaging tests to determine the extent of damage. These tests may include:

• X-rays.
• Magnetic resonance imaging (MRI).
• A CT (computed tomography) scan.

Management and Treatment

How is a posterior cruciate ligament injury treated?

It depends on the severity of your PCL injury. Common posterior cruciate ligament treatments include:

• Crutches. Your healthcare provider may recommend using crutches to limit how much weight you put on your knee.
• Knee brace. Bracing your knee can address instability — a common PCL symptom.
• Physical therapy. Certain exercises can help strengthen and stabilize your knee.
• Surgery. If your PCL injury is severe, surgery may be necessary for full rehabilitation. In most cases, knee arthroscopy is performed to reconstruct your ligament. This procedure is less invasive compared to traditional surgical methods.

Are there complications following PCL surgery?

Though complications are rare, there are certain risks associated with knee arthroscopy. These include:

• Infection.
• Bleeding.
• Blood clots.
• Swelling.
• Stiffness of the knee joint.

How long does a PCL injury take to heal?

Recovery time can vary from person to person. If your injury is mild, it may only take about 10 days to heal. If you’ve had surgery to repair your PCL, recovery could take about six to nine months.

How can I manage symptoms at home?

If you’ve injured your PCL, there are ways to ease discomfort and promote healing. Recommendations include:

• Rest. Avoid any activity that places unnecessary stress on your knee.
• Ice. Apply a cold compress to the knee for 15 minutes, four times a day.
• Compression. Wrapping your knee in an elastic bandage helps reduce swelling.
• Elevation. Prop your leg up on a pillow so it’s above the level of your heart.
• Pain relievers. Take non-steroidal anti-inflammatory drugs (NSAIDs) to ease pain and swelling.

Prevention

How can I prevent posterior cruciate ligament injuries?

It can be difficult to prevent PCL injuries altogether. However, there are several things you can do to reduce your risk:

• Stretch before physical activities to keep your knee joints healthy.
• Use proper techniques when walking or running.
• Stay alert and use caution when playing sports.

Outlook / Prognosis

What can I expect if I have a posterior cruciate ligament injury?

If your PCL injury is minor, you may heal without complications. However, if the ligament sustained severe damage, your knee could become weak and prone to re-injury unless you have surgery.

People who undergo PCL surgery generally notice improved stability and mobility following recovery. Keep in mind, however, you may still need to wear a knee brace during physical activities to protect your joint.

When can I go back to work or school?

If you have a sedentary office job, you’ll be able to return to work rather quickly. However, if you have a job that requires physical exertion, such as lifting, you’ll need a few more weeks to recover. Ask your healthcare provider when you can return to work or school after your PCL injury.

Living With

When should I see my healthcare provider for a posterior cruciate ligament injury?

Prompt medical attention is necessary after a serious PCL injury. You should contact your healthcare provider if:

• You have pain or swelling.
• You feel like your knee is unstable.
• Your foot feels numb.
• Your leg or foot changes color or feels cold.

If you are exhibiting any of these symptoms, seek care immediately. Your medical team can determine the cause of your knee pain and design a treatment plan to fit your needs.