Posterior cruciate ligament tears account for about 3% of outpatient knee injuries and rarely occur in isolation. In fact, up to 95% of PCL tears occur along with tears of other knee ligaments. Surgical and nonsurgical treatment options are available to treat PCL tears.
Traditionally isolated PCL tears have been treated without surgery because of the inherent healing capacity of the PCL, even when the injury meets criteria for surgical reconstruction. Still the long-term outcome of conservative management has been less than optimal.
A Grade 3 tear indicates a severe PCL injury combined with injury to other knee ligaments will involve knee instability. Newly reported outcomes of conservative treatment for Grade 3 or 4 PCL tears have been found to increase the risk of degenerative changes in the knee, and poor function. In these cases, surgical reconstruction is often recommended for young and active patients.
Today, improved understanding of the role of the PCL in proper knee mechanics and the negative consequences of chronic PCL insufficiency when treated non-operatively has driven advancements in surgical technique and graft options for PCL reconstruction.
When is PCL Reconstruction recommended?
PCL ligament reconstruction surgery will be recommended for symptomatic complete tears as well as for PCL tears combined with other joint injuries. The goal is to restore normal knee stability and return the patient to pre-injury function. Surgery has been shown to improve patient outcomes.
What is PCL reconstruction surgery?
PCL reconstruction is minimally invasive surgery to reconstruct and replace the damaged PCL with a tendon tissue graft. It is outpatient surgery performed under general or regional anesthesia. Minimally invasive surgery provides a multitude of benefits and produces good outcomes by sparing healthy tissues; reducing tissue damage and bleeding; and scarring.
The surgery will require several incisions to insert the arthroscope and surgical instruments, to remove the damaged ligament and to insert and attached the grafts to the bone.
Autograft or Allograft?
The graft may be either an autograft or an allograft. An autograft is a tendon obtained from the patient, typically it is the patient’s patellar tendon or hamstrings or quadriceps tendons. When the patient does not have a suitable graft or enough graft tissue, donor graft tissue will be used. In fact, allografts are the most commonly used option because they are safe and provide sufficient graft strength without the concerns of using donor tissue. Using allografts eliminates risks and reduces the size and number of incisions. Dr. Cooper will discuss with you his recommendations for graft choice.
Recovery from PCL reconstruction surgery
Patients will use crutches and a brace to prevent bending the knee for the first few days. Rehabilitation begins within a week of surgery and is designed to increase strength, range of motion and balance. Weight bearing is restricted for at least the first six weeks. Return to play can take up to nine months. Full recovery can take up to a year to fully recover, particularly when there were other knee ligament injuries that required reconstruction.
When you need orthopedic services for a PCL tear, contact Dr. Joe Cooper. He is an expert with the knowledge, skills and experience to provide you with the best care available.
