Posterior Cruciate Ligament (PCL) Injury

Anatomy Your posterior cruciate ligament (PCL) is located in the middle of the knee joint, connecting the shin bone (tibia) to the thigh bone (femur). It crosses over diagonally with the anterior cruciate ligament (ACL) to control the backward and forward movement of the knee at the joint. The PCL is one of four strong stabilising ligaments of the knee, along with the ACL and the medial and lateral collateral ligaments. The PCL works to stop the tibia from sliding backwards on the femur, as well as preventing the tibia from twisting outwards.  

What causes a PCL injury?

PCL injuries are often sustained from high-impact forces while the knee is bent, forcing the tibia back on the femur. These can occur in sports like soccer, football and skiing, among others. The different levels of severity of injury include a ligament sprain, a partial tear, or a complete rupture. The most common of these for PCL injuries is partial tears. Causes include:

• Direct impact/trauma to the knee, such as from tackles
• Falling with the knee in a bent position
• Hitting the knee against a car dashboard while it is bent
• Twisting or hyperflexing the ligament
• Mislanding a jump

PCL injuries often occur alongside other knee injuries such as a lateral meniscal tear. They are less common than ACL injuries because of the greater strength and thickness of the PCL. This can make them more difficult to assess compared to other ligaments of the knee.  

What are the symptoms?

Typically, PCL injuries initially present as a minor knee pain that can be ignored until further symptoms develop. Depending on the severity of your injury, symptoms may include:

• Feeling unstable, like your knee is giving out from under you
• Pain and tenderness in the knee joint, particularly on walking
• Swelling
• Tenderness may radiate to the calves over time

 

How are PCL injuries treated?

When the injury first occurs, it’s important to stop physical activity and avoid walking on the affected knee where possible. Following the PRICE principles (protection, rest, ice, compression and elevation) can help reduce the initial pain and swelling. If you have had a rupture or significant tear to your PCL, you may require surgery. It’s important that you have a diagnosis to confirm the extent of your injury, which may involve having an ultrasound, x-ray or MRI imaging. The good news is that partial tears to the PCL do have a greater capacity to heal on their own without causing long-term instability issues. Your podiatrist can help you gradually rebuild the strength in your knee and surrounding muscles and improve the range of motion in the joint. Your podiatrist will make recommendations based on the cause of your injury to both help your recovery and reduce the risk of re-injury in the future. This may look at the use of orthotics to control motion at the feet and legs, assessing the stability of your footwear, teaching you how to strap your knee where beneficial, and physical therapy.