Posterior cruciate ligament PCL

PCL Injuries Can Be Successfully Treated Without Surgery

Posterior cruciate ligament PCLWhile not as common as anterior cruciate ligament (ACL) injuries, PCL, or posterior cruciate ligament, injuries do occur and can cause some serious issues with your knee if not addressed adequately.  PCL injuries can occur from common mechanisms such as a fall onto the front of your knee, car accidents, or sports injuries.  Surgery is sometimes recommended to reconstruct the ligament, though outcomes do not tend to be as successful as ACL injuries over time.

People with PCL injuries tend to have increased looseness of their knees and can develop signs of early knee arthritis.  Physical therapy is commonly recommended in an attempt to restore function and minimize the development of arthritis by strengthening the muscles that control the knee.

 

PCL Injuries Can Be Successfully Treated Without Surgery

A recent study publish in the prestigious American Journal of Sports Medicine demonstrated that PCL injuries can be successfully treated without surgery.  The authors of the report followed a group of people that had isolated PCL injuries for up to 21 years to study what happened to these people, and their knees, over time.

Long term results indicated that people with PCL injuries can remain active, have good strength and mobility, and remain satisfied in their knee without surgery.

Almost 90% of the people did not develop signs of arthritis.

In our mind, the key to these great long term results is appropriate physical therapy after the injury and remaining active over the years through fitness programs.  You have to keep the knee strong.

PCL RehabilitationWe know that a PCL injury is going to make the knee more vulnerable to arthritis, so we really emphasize strengthening the muscles of your knee and leg to help stabilize the knee and reduce forces to your joint and cartilage.  By remaining strong and active, you maximize your chances of not having issues with your knee in the future.  The time you put into your knee now can really help prevent issues down the road.

Our focus of rehabilitation is to keep the leg strong and stable by incorporating a combination of strengthening exercises and dynamic stability exercises.

One of the most important muscles groups to focus on are your quadriceps.  One of the quads many jobs is to help the PCL stabilize the knee by controlling the tibia and preventing posterior tibial translation.  By keeping the quad strong, there is less force on your PCL.  This same principle applies to the hip musculature as the hip tends to control the entire leg.

Biomechanics of Strain on the PCL

Equally important as focusing on the right muscle groups is avoiding exercises that may place excessive stress on your PCL.  Through some of our biomechanical research, we have helped identify specific exercises that you want to avoid after an injury, such as hamstring curls, which could stress your injured posterior crucial ligament.

When you look at the below graph, you can see that strain on the PCL increases the more you flex in the knee in both open chain (like knee extension) and closed chain (like squat) exercises.

PCL biomechanical forces
The large peak in the graphs represents a high amount of strain on the PCL.  In the knee with a deficient PCL, this will produce strain and laxity to the joint, which will eventually cause excessive wear on the cartilage of the knee and patellofemoral joint.

Rehabilitating a PCL injury or participating in a fitness program with a past PCL injury isn’t simple and group cookie-cutter programs should be avoided.  You need to find someone that truly understands the impact of PCL injuries on how your knee functions.  This is one of the main reasons we feel that everyone’s specific physical therapy and fitness programs should be individualized.

As you can see, there are exercises and muscle groups you want to emphasize and others you want to avoid.

A posterior cruciate ligament injury doesn’t have to slow you down – great results have been reported if you follow appropriate rehabilitation guidelines after the PCL injury and then remain active and keep the leg strong to minimize your chances of early arthritis.

 

 

31 replies
  1. Dan Lorenz
    Dan Lorenz says:

    Nice article Mike on a little talked about injury. Still have many closed chain options for the hamstrings with the feet on the ground and the tibia vertical to make sure we still get some hamstring work in. Thanks for the summary!

    Reply
  2. Wendy Zeigler
    Wendy Zeigler says:

    Thank you for this article. As a PT who just had PCL surgery in April, I would like to mention the posterior-lateral corner. I think many do not evaluate this area as part of the PCL testing. I tore my PCL 4 years ago, did the non-surgical rehab route, but once I tore my posterior lateral corner (mainly from telemark skiing) surgery became a must. As PT’s we need to work on the popliteus, assess the integrity, and evaluate which portion of the hamstring is dominant, for example, if someone is using predominantly the biceps femoris, my experience is that this can cause further problems. Keep up the great info!

    Reply
  3. J Rogers
    J Rogers says:

    I tore my PCL 6 years ago. Since then I have run my first marathon, 6 now total with zero joint pain, multiple ultra marathons and trail runs. Staying strong, developing your eccentric quad control and dynamic balance ability is key. Correct pelvic asymmetries. If I slack off over time and lose my strength then I have pain and feel my knee joint slide around. Stay active everyone.

    Reply
  4. Greg Arnold, DC, CSCS
    Greg Arnold, DC, CSCS says:

    I suffered a complete tear of my left PCL playing basketball back in 1997 while at Penn State and had complete recovery without surgery. All quad work, no hamstrings. I think it took about 8 weeks but that was 17 years ago so I could be off with rehab time.

    Reply
    • Tim Nep
      Tim Nep says:

      Greg, are you still playing basketball? I just suffered a complete tear of my PCL two weeks ago, and I’m worried about my lifestyle going further. I’m very active, and have been a multi sport athlete my entire life. I’m not in a place where I want to slow down anytime soon, so I’m wondering if I should get the surgery or not. Just wondering if you’ve had to alter your activities since the injury.

      Thanks,
      Tim

      Reply
  5. Andrea McCartney
    Andrea McCartney says:

    The knees are complex mechanisms and this study is very interesting. Tthe more we learn about knees, the more treatments we can develop for PCL injuries and more.

    Reply
  6. Praveen Kumar
    Praveen Kumar says:

    I got a isolated partial pcl tear few weeks ago. The ligament is quite stretched as well. My doctor suggested me to get a surgery but I am still thinking what is the best thing for me to do. I’m able to jogg and move around quick but sometimes i feel my knee is unstable and in sleep sometimes my hamstring contracts strongly and that causes a lot of pain. I used to be able to run a lot. I don’t want a sedentary lifestyle. I’m confused. I’m thinking i’ll try to non surgical route and see if I can get considerable improvement or else I’ll go for a surgery.

    Reply
    • Vimal k. Sharma
      Vimal k. Sharma says:

      I am also feeling same Sir. I got injury before one month ago. Doctors said for surgery of pcl (complete tear) but I went to dr. Manish dixit best physiotherapists. He is hard-working for my pcl repairing. I am also confused that I should go for surgery or not. Which way is the best….???

      Reply
  7. Chirag Patel
    Chirag Patel says:

    Hello sir i have suffer from Posterior Ligament Injury. MRI result show thas it is on 3rd stage and i want to know that how can i overcome from this. It is possible to repair may ligament whitout operation or it is should be? Please sir reply me as soon as possible.

    Reply
  8. Waqar anjum
    Waqar anjum says:

    My pcl teard 1year ago…i can run as well but could not bend after running,lot of pain…
    I did a complete exercise drill for 2 month..but when i ran after a long time again pain started…
    Im confused about it plz help me…im a crickter

    Reply
  9. Jordan diaz
    Jordan diaz says:

    Complete pcl rupture no other damage to anything else 6 weeks of rehab cti brace played in football game I did well until I fell on my knee stung for about a minute could have went back out will this continue to happen unless I get surgery

    Reply
  10. Mackenzie
    Mackenzie says:

    I tore my PCL completely from a fall on the sidewalk while running. I actually feel twice about two months apart. I am currently doing stretches/exercises recommended by my PT. I am an avid runner who was training for another marathon when I fell. I am now easing back into running. Any advice on how to construct my running plan at this point? I am thinking intervals will work best, but thoughts on run/walk ratio? The first time I tried running two days ago, I experienced pain after running 1 mile straight. Later that day, I intervalled and felt great until after about a mile and two miles, maybe a little less. My knee was very stiff the next day.

    Reply
  11. Dale
    Dale says:

    My son is a 18 year old football player with a complete tear of PCL with no other tissues affected. He wants to continue playing football. I have a rehab degree and feel surgery for PCL is questionable at best. He exercises routinely and feels good but lacks stability. Any opinions on braces or new interventions?

    Reply
  12. Minakshi
    Minakshi says:

    I met with the road accident n had pcl avulsion fracture type 3 .nothing else injured .after 21 days of bed rest there is no effusion n callus formation started between fractured bone .but still I cant fold my leg n can not sit down on floor .don’t wanna go for surgery .is it possible that it will be completely alright by the time. ?

    Reply
  13. DAVE RIDENOUR
    DAVE RIDENOUR says:

    My daughter had a grade 2-3 tear of the PCL. She went thru rehab for approx 1 year and was cleared to go back to sports. The knee was doing great but lately it freq gives out. Does she need furthur rehab or consider surgery? Also, what are your thoughts on wearing knee brace for it?

    Reply
  14. David
    David says:

    Can anyone speak to how soon after the injury to start PCL physical therapy? I had a complete tear and my doctor has me in a leg brace and crutches with no physical therapy for three months. It seems counter to your article as far as strengthening the other muscles. Thank you.

    Reply
  15. Mohamed
    Mohamed says:

    Hi.. Im a runner and i 20.
    I tore my pcl 6 year ago in accident….
    I want to know best rehab for me what?
    I need surgery???

    Please answer me..

    Reply
  16. Ann
    Ann says:

    Hey I’m 53 years old had a bad fall on July 1st complete tear of my pcl small tear mcl see surgon on the August 14th still very swollen and painful to move therapist said i would need surgery to repair pcl but im worried about the outcome because of my age 😢

    Reply
  17. Sean
    Sean says:

    Hi
    4 months ago I injured my PCL competing in jiu jitsu.

    Eventually got a MRI showing I have a near full thickness midsubtance rupture of the PCL.

    Just seen the surgeon today, which has told me I need PCL Repair using a artificial ligament called LARS. (He give me no other options, which I found to be strange)

    He told me that the surgery will give me strength and stability back but will limit my flexibility.

    My main concern is that my sport requires about of flexibility.

    Any ideas guys I really don’t want to slow down, as I’m only 27 :(

    Reply

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