Posterior cruciate ligament injury


Posterior cruciate ligament injury

Description, Causes and Risk Factors:

Abbreviation: PCLI.

The knee is similar to a hinge joint, located where the end of the femur (thigh bone) meets the top of the tibia (shin bone). Four main ligaments connect these two bones:

    ACL (anterior cruciate ligament): Lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.

  • PCL (posterior cruciate ligament): Works with the ACL. It prevents the tibia from sliding backwards under the femur.

  • MCL (medial collateral ligament): Runs along the inner part (side) of the knee and prevents the knee from bending inward.

  • LCL (lateral collateral ligament): Runs along the outer part (side) of the knee and prevents the knee from bending outward.

The posterior cruciate ligament (PCL) is the strongest ligament in the knee. It extends from the top-rear surface of the tibia (bone between the knee and ankle) to the bottom-front surface of the femur (bone that extends from the pelvis to the knee). Injuries to the PCL are not as common as other knee ligament injuries. In fact, they are often subtle and more difficult to evaluate than other ligament injuries in the knee.

The ligament prevents the knee joint from posterior instability. That means it prevents the tibia from moving too much and going behind the femur.

Many times a PCL injury occurs along with injuries to other structures in the knee such as cartilage, other ligaments, and bone. The PCL is usually injured by overextending the knee (hyperextension). This can happen if you land awkwardly after jumping. The PCL can also become injured from a direct blow to the flexed knee, such as smashing your knee in a car accident (called "dashboard knee") or falling hard on a bent knee.

Athletes in sports such as football or soccer may tear their PCL when they fall on a bent knee with their foot pointed down. The shinbone hits the ground first and it moves backward. Being tackled when your knee is bent also can cause this injury.

Most PCL injuries occur with other ligament injuries and severe knee trauma. If you suspect PCL injury, it is important to be seen by a medical professional immediately.

Symptoms:

The typical symptoms of a posterior cruciate ligament injury are:

    Pain with swelling that occurs steadily and quickly after the injury.

  • Swelling that makes the knee stiff and may cause a limp.

  • Difficulty walking.

  • The knee feels unstable, like it may "give out."

Diagnosis:

During your first visit, your doctor will talk to you about your symptoms and medical history.

During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Your injured knee may appear to sag backwards when bent. It might slide backwards too far, particularly when it is bent beyond a 90° angle.

Imaging Studies May Include:

    X-rays: Although they will not show any injury to your posterior cruciate ligament, X-rays can show whether the ligament tore off a piece of bone when it was injured. This is called an avulsion fracture.

  • MRI: This study creates better images of soft tissues like the posterior cruciate ligament.

  • Arthroscopy: If it is unclear how extensive your knee injury is, your doctor may use a surgical technique called arthroscopy to look inside your knee joint. A tiny video camera is inserted into your knee joint through a small incision. The doctor views images of the inside of the joint on a computer monitor or TV screen.

Treatment:

If you have injured just your PCL, your injury may heal quite well without surgery. Your doctor may recommend simple, nonsurgical options:

    RICE (rest, ice, gentle compression and elevation) can help speed your recovery.

  • Medications: Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), can help relieve pain and reduce swelling.

  • Immobilization: Your doctor may recommend a brace to prevent your knee from moving. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

  • Physical therapy: As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps) has been shown to be a key factor in a successful recovery.

Surgical Treatment:

Your doctor may recommend surgery if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the PCL, surgery is almost always necessary.

Rebuilding the ligament: Because sewing the ligament ends back together does not usually heal, a torn posterior cruciate ligament must be rebuilt. Your doctor will replace your torn ligament with a tissue graft. This graft is taken from another part of your body, or from another human donor (cadaver). It can take several months for the graft to heal into your bone.

Procedure: Surgery to rebuild a PCL is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

Surgical procedures to repair PCL continue to improve. More advanced techniques help patients resume a wider range of activities after rehabilitation.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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