Knee injury - posterior cruciate ligament (PCL)

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Alternative names
Cruciate ligament injury - posterior; PCL injury; Posterior cruciate ligament (PCL) injury

Definition

A posterior cruciate ligament injury is described as a partial or complete tear, or stretching of the posterior cruciate ligament (PCL) anywhere along the length of the ligament.

Considerations

A physical examination shows signs of PCL injury. This includes “positive” findings when manipulating the knee joint in various ways (these manipulations are called a posterior drawer test and a quadriceps active drawer test).

Another physical examination technique that allows the practitioner to detect the presence of fluid in the knee joint (the ballottement test) may show joint bleeding (hemarthrosis).

PCL injury may be seen on the following procedures:

• a knee MRI
  
• a knee joint X-ray

Causes
The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability—that is, instability in the back of the joint.

The PCL is usually injured by hyperextension (overextending the knee), or a direct blow to the flexed knee (such as from “dashboard knee” in a car accident).

Symptoms

• knee swelling and tenderness in the space behind the knee (popliteal fossa)
  
• knee joint instability
  
• knee joint pain

First Aid

Initial treatment of a PCL injury includes splinting, ice to the area, elevation of the joint (above the level of the heart) and nonsteroidal anti-inflammatory drugs (NSAIDS) for pain.

Limit physical activity until the swelling is down, motion is normal, and the pain is gone. Physical therapy should be involved to help regain joint and leg strength. If the injury is acute, and/or you have a high activity level, surgery may be necessary. This may be either knee arthroscopy or “open” surgical reconstruction.

Age has an effect on treatment—younger patients are more likely to have problems without surgery, as reattachment can be more difficult.

Call immediately for emergency medical assistance if
Call your health care provider if symptoms of PCL injury occur.

Call your health care provider if you are being treated for PCL injury and you notice increased instability in your knee, if pain or swelling return after they initially subsided or if your injury does not appear to be resolving with time.

Also call if you re-injure your knee.

Prevention
Use proper techniques when playing sports or exercising. Many cases are not preventable.

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