Patient Information Handout: Posterior Cruciate Ligament Injury (also called PCL rupture)

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.

5. Investigations

  • 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.

6. Treatment

  • 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.

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