The Posterior Cruciate Ligament (PCL), is the strongest ligament of the knee. While the Anterior Cruciate Ligament (ACL) is injured more often than the PCL and is more commonly discussed, PCL injuries account for more than 20% of reported knee injuries. Because the ACL sits just in front of the PCL, injuries to the PCL are commonly missed and left undiagnosed.
The posterior cruciate ligament’s most important function is to prevent posterior translation of the knee at higher knee flexion angles. Thus, patients commonly complaining of problems with deceleration, problems going down stairs and inclines or general twisting, turning or pivoting activities.
PCL injuries are classified according to the amount of injury to the functional ligament:
• Grade I: partial PCL tear
• Grade II: near complete PCL tear
• Grade III: a complete PCL tear – the ligament is non-functional
In general, Mr Sethi will perform a PCL reconstruction on injuries that present themselves as a grade III. In a higher level athlete, it may be recommended to proceed with a PCL reconstruction sooner because the results of acute reconstructions are much better than chronic reconstructions.
When Mr Sethi does find that a patient needs a surgical PCL reconstruction, he thoroughly assesses the patient to see if there is a concurrent injury.
PCL Reconstruction Technique
Mr Sethi’s surgical PCL reconstruction technique involves the creation of a closed socket tunnel in the femur for the graft of the PCL reconstruction. The graft is fixed in that location and pulled distally down the tibia. The is then fixed to the tibia.
Postoperatively, we allow patients to initiate knee flexion at 0-90° on day one. The patients use a PCL brace postoperatively at all times, except to shower or change clothes, to reduce the posterior gravitational stress to the knee.