By Dr. Chris Milne, Sports Physician
1. What is it?
It is a disruption of the posterior cruciate ligament. This one of the main supporting and stabilising ligaments of the knee joint.
2. What causes it?
It is usually caused by a hyperextension or forced flexion injury to the knee.
3. Symptoms – what you notice
- Pain – in the middle or back of the knee which is worse with running.
- Inability to accelerate rapidly.
- Instability – if there is damage to the posterolateral complex, you may also experience instability.
- Such an injury is rare on the football field, but may occur in motocross or other high speed accidents.
4. Signs – what the doctor finds
- A positive posterior sag test – this test is performed with both knees flexed to 90°.
- A positive posterior drawer test – this test is performed by pushing the tibia (shin bone) backwards and is positive is there is pain or increased movement compared with the other knee.
- X-rays are important to exclude any bony problem in the knee. It is often necessary to perform an
- MRI scan to assess any damage to other structures that may be injured in association with the posterior cruciate ligament.
- First aid – an ice pack applied to the back of the knee may be helpful. Take Panadol or anti-inflammatory tablets.
- This injury is difficult to diagnose and it is often necessary to get specialist review to be sure of the nature of the problem.
- Most posterior cruciate injuries can be managed via a standard rehabilitation programme (see below).
- If there is evidence of associated damage to the posterolateral complex, surgical reconstruction should be considered.
7. Recovery time
Average recovery time is 4-12 weeks. It is about 6 months if surgical reconstruction is undertaken.
8. Recovery sequence
- Step 1 Ice packs, pain relief.
- Step 2 Regain full extension in the knee.
- Step 3 Physiotherapy supervised rehabilitation to build up quadriceps and hamstring function. This
- includes daily exercise such as stair climbing.
- Step 4 Cycling and swimming.
- Step 5 Restart gentle running and progress to stop-start then multidirectional activity.
- Step 7 Team training and skill sessions.
- Step 8 Resume playing, half game at first.