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Health news headlines can be deceiving. Why is topical vitamin C important for skin health? Preventing preeclampsia may be as simple as taking an aspirin. Caring for an aging parent? Tips for enjoying holiday meals. A conversation about reducing the harms of social media. Posterior cruciate ligament PCL injury happens far less often than does injury to the knee's more vulnerable counterpart, the anterior cruciate ligament ACL.
The posterior cruciate ligament and ACL connect your thighbone femur to your shinbone tibia. If either ligament is torn, it might cause pain, swelling and a feeling of instability. Ligaments are strong bands of tissue that attach one bone to another. The cruciate KROO-she-ate ligaments connect the thighbone femur to the shinbone tibia.
The anterior and posterior cruciate ligaments form an "X" in the center of the knee. Although a posterior cruciate ligament injury generally causes less pain, disability and knee instability than does an ACL tear, it can still sideline you for several weeks or months. If there are no associated injuries to other parts of your knee, the signs and symptoms of a posterior cruciate ligament injury can be so mild that you might not notice that anything's wrong.
Over time, the pain might worsen and your knee might feel more unstable. If other parts of your knee have also been injured, your signs and symptoms will likely be more severe.
The posterior cruciate ligament can tear if your shinbone is hit hard just below the knee or if you fall on a bent knee. These injuries are most common during:. Non-operative treatment of a partial PCL tear involves a period of immobilization of the knee followed by intensive treatment by a skilled physical therapist. A short period of immobilization of the knee in a brace or even sometimes a cast may be necessary to allow the PCL to heal first.
Early emphasis in physical therapy is on reducing knee swelling and obtaining full knee range of motion. Following this, the focus of physical therapy becomes strengthening the surrounding musculature of the knee which provides dynamic stabilization.
Most importantly is quadriceps strengthening because they pull the tibia in a forward anterior direction and therefore counteract the backward sag of the tibia seen when a PCL is torn. Also, core and hip stabilization are important to regain maximum control over the entire lower extremity. This also helps develops this muscular control for their sport and maximize athletic performance.
In many cases, an injured athlete can return to sports participation in about 4 — 6 weeks although this may be shorter or longer depending on how severe the injury is and how well the athlete responds to therapy.
In most cases of a complete PCL injury, surgical treatment is performed. The new ligament graft can be from many sources, however most commonly it is an allograft tissue graft from a cadaveric donor.
Which specific allograft tissue is up to the discretion of the operating surgeon and may be taken from one of various tendons of the ankle or from the quadriceps tendon at the knee. Then the injured PCL is removed with the help of the arthroscope small camera using a few very small incisions. Any other associated cartilage and meniscus injury can be treated at the same time.
Then a tunnel is created in the end of the thigh bone femur where the PCL attaches. The bone where the PCL attaches to the back of the lower leg tibia is also prepared to receive the graft. The new PCL graft is then connected to the bone at each end with one of various fixation devices screws or staples and therefore recreates the PCL. Because much of the surgery for a PCL reconstruction is performed in the back of the knee, there is a greater risk of a nerve or blood vessel injury than in most knee surgeries.
It is important that an athlete is checked both during and after surgery that damage to one of these important structures did not occur. There are some hotly debated controversies in PCL reconstruction. These involve whether a single large graft or a double-bundle graft with 2 smaller limbs should be used. There is some evidence the double-bundle graft may be mechanically stronger. However, there has been no clinical evidence that patients do better with one versus the other.
Another controversy involves how the graft is attached to the back of the tibia. One technique involves performing the surgery almost entirely through the small incisions with the help of the arthroscope.
The other technique tibial inlay involves making a larger incision at the back of the knee and directly attaching the new PCL graft at that point. There is some evidence that performing the surgery in this manner is more mechanically advantageous to the graft.
The graft might not be stretched as much and may have a lower rate of failure. The ideal technique of PCL reconstruction may vary somewhat on a case by case basis and therefore would normally be discussed with the treating sports medicine surgeon. Recovery following surgical treatment of a PCL tear requires a long course of physical therapy. Initial treatment focuses on regaining range of motion and decreasing the swelling in and around the knee.
Early quadriceps retraining is very important to regain control of the knee. Then over the course of months the rehab is progressed to a functional program with a goal of returning an athlete to their sport. This often takes 6 months to a year of rehab.
Early on in returning to sports participation, an athlete may wear a protective brace although for how long is determined by the surgeon who performs the surgical reconstruction. With just seven weeks of regular football left and the Warriors highly unlikely to … Casualty Ward round Shaun Johnson good news, Jacob Liddle injures shoulder — Fox Sports. It allows you to quickly and conveniently speak with a sports doctor or specialist and have an effective alternative to emergency room, urgent care, or waiting for a doctors appointment.
You can get Virtual Care from your home or anywhere via phone or video chat. Evaluation and treatment of posterior cruciate ligament injuries: revisited.
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