Knee injury - posterior cruciate ligament (PCL)
Key points
- 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.
- 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).
- 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.
- Call your health care provider if symptoms of PCL injury occur.
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.
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
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