PCL Reconstruction

Dr. Rahul Damle – PCL Reconstruction Specialist

Introduction

The Posterior Cruciate Ligament (PCL) is one of the less commonly injured ligaments of the knee.

Anatomy

Ligaments are strong bands of muscle that connect the ends of bones. The PCL is placed near the back of the knee joint. It attaches to the back of the femur (thighbone) and the back of the tibia (shinbone) behind the ACL.

The PCL is the main stabilizer of the knee and the main controller of how very backward the tibia moves under the femur. If the tibia goes too Also important in the decision about surgery is the rising recognition by orthopedic back, the PCL can rupture.

The PCL is sometimes injured along with the ACL or the Posterolateral Ligamentous complex.

Causes

The most popular way for the PCL alone to be injured is from a direct blow to the front of the knee while the knee is bent. Since the PCL controls how far backward the tibia moves about the femur, if the tibia moves too far, the PCL can rupture. The most common reason for the PCL to be injured is during an automobile accident and sports.

Symptoms

Most patients with a PCL injury feeling of stiffness and some swelling. Patients may also have a feeling of instability and giving way of the joint, particularly when trying to change direction on the knee. The knee may feel like it wants to move.

The pain and reduced swelling from the first injury will usually be gone after 2 to 4 weeks, but the knee may still feel unstable. The sign of instability and the inability to take the knee for comfort are what require treatment. Also important in the choice about treatment is the growing realization by orthopedic surgeons that long-term instability leads to early arthritis of the knee.

Diagnosis

Inspections are also done to understand if other knee ligaments or joint cartilage have been damaged. X-rays of the knee are ordered to rule out a fracture. Ligaments and muscles do not show up on X-rays.

The magnetic resonance imaging (MRI) scan is probably the most reliable test without actually looking into the knee. In some cases, arthroscopy may be used to make the ultimate determination if there is a question about what is causing your knee problem.

Treatment

Nonsurgical Treatment
Partial PCL tears are usually treated with a progressive rehabilitation program. Patients intending to return to activities may require a functional knee brace before returning to these activities.
Exercises are used to help you retrieve the normal action of joints and muscles.
Exercises are also given to increase the power of the quadriceps tissues on the front of the thigh.

Surgery
If the PCL is torn, nonsurgical treatment may not work for most patients.
Patients usually do better-having surgery within some weeks after the injury.
The main goal of surgery is to regain stability and to get the knee functioning normally again.
This surgery is most often done Arthroscopically
Incisions are normally still needed around the knee, but the surgery doesn’t need the surgeon to open the joint.
In a typical surgical reconstruction, the torn ends of the PCL must first be removed. Once this has been done, a graft will be used to substitute for the torn PCL.
Either a quadrupled hamstring tendon or a Patellar tendon or Central Quads tendon is used.
Next, the doctor prepares the knee to place the graft. The remnants of the original ligament are removed. Holes are then drilled in the tibia and the femur to place the graft. These holes are fixed so that the graft will go between the tibia and femur in the same direction as the original PCL.
The graft is then drawn into place through the drill holes. Screws and Endobuttons / Tightropes are used to hold the graft inside the drill holes.

Complications

As with all major operational methods, complications can happen.
Some of the most usual difficulties following hamstring tendon graft reconstruction of the ACL are
1. Thrombophlebitis /DVT
2. Infection
3. Problems with the graft
After surgery, the body strives to produce a network of blood vessels in the new graft. This process, called revascularization, takes about 12 weeks. The graft is weakest during this time, which means it has a greater chance of stretching or rupturing if pushed too hard!

After Surgery

Each patient will have an individualized physiotherapy program depending upon other concomitant injuries & reconstructions done.
In most cases, a cast brace may be used for the first few weeks. Most patients stay one night in the hospital post-operatively. The tube put in your knee at the end of the surgery is normally removed after 24 hours.
You’ll use crutches for 4-6 weeks to keep your knee safe and prevent the graft from stretching out.

Rehabilitation

Patient-specific exercises are designed to help control the pain and swelling from the surgery. The aim is to help you recover full knee extension as soon as possible.
The physical therapist will choose methods to get the thigh tissues toned and active again.
Patients are advised about exhausting their hamstrings in the first 6 weeks after surgery.
As the rehabilitation program grows, more challenging activities are taken to safely advance the knee’s strength and function. Specialized balance exercises are used to help the tissues react swiftly and without thinking. This part of the treatment is called neuromuscular training.
When you get good knee movement, your knee isn’t swelling, and your strength and muscle control are improving, you’ll be able to gradually go back to your work and sports activities. Some doctors prescribe a practical brace for players who intend to return Ideally, you’ll be able to continue your past lifestyle activities.

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