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Posterior cruciate ligament (PCL) injury

A posterior cruciate ligament injury is a partial or complete tearing or stretching of any part of the posterior cruciate ligament (PCL), which is located inside the knee joint.

Alternative Names

Cruciate ligament injury - posterior; PCL injury; Knee injury - posterior cruciate ligament (PCL); Hyperextended knee

Considerations

Your doctor will perform a physical examination to check for signs of PCL injury. This includes moving the knee joint in various ways.

Your doctor may also check if there is fluid in the knee joint. This test may show bleeding into the joint.

These tests may be ordered:

Causes

The posterior cruciate ligament (PCL) is the strongest ligament in the knee. It extends from the top-rear surface of the tibia (bone between the knee and ankle) to the bottom-front surface of the femur (bone that extends from the pelvis to the knee).

The ligament prevents the knee joint from posterior instability. This means it prevents the tibia from moving too much and going behind the femur.

The PCL is usually injured by overextending the knee (hyperextension). This can happen if you land awkwardly after jumping. The PCL can also become injured from a direct blow to the flexed knee, such as smashing your knee in a car accident (called "dashboard injury") or falling hard on a bent knee.

Most PCL injuries occur with other ligament injuries and severe knee trauma. Often the knee is dislocated and the nerves and blood vessels are injured. If you suspect PCL injury, it is important to be seen by a doctor right away.

Symptoms

  • Knee swelling and tenderness in the space behind the knee (popliteal fossa)
  • Knee joint instability
  • Knee joint pain

First Aid

At first, a PCL injury is treated by:

  • Checking the pulse and circulation in the area
  • Splinting
  • Applying ice to the area
  • Elevating the joint (above the level of the heart)
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain

Limit physical activity until the swelling is down, motion is normal, and the pain is gone. Physical therapy can help you regain joint and leg strength. If the injury happens suddenly (acute ) or you have a high activity level, you may need surgery. This may be either knee arthroscopy or open surgical reconstruction.

Age has an effect on treatment. Younger patients are more likely to have problems without surgery, because chronic instability may lead to arthritis symptoms many years later. Many people do well without surgery. Injuries in which the bone is pulled off with the ligament, or multiple ligaments are injured need to be repaired with surgery.

When to Contact a Medical Professional

Call your health care provider if:

  • You have symptoms of PCL injury
  • You are being treated for PCL injury and instability in your knee worsens
  • Pain or swelling return after they went away
  • Your injury does not appear to be getting better with time
  • You re-injure your knee
  • You have loss of sensation and decreased circulation in your foot

PCL injuries often occur with other ligament injuries or severe knee trauma. You should be checked early for these other conditions.

Prevention

Use proper techniques when playing sports or exercising. Many cases are accidents and are not preventable.

References

Honkamp NJ, Ranawat AS, Harner CD. Knee: Posterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2009:chap 23, section E.

Honkamp NJ, Ranawat AS, Harner CD. Knee: Posterior cruciate ligament injuries in the child. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2009:chap 23, section E.

Updated: 4/16/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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