Posterior Cruciate Ligament (PCL) Injuries

A PCL injury is a sprain or tear of the posterior cruciate ligament (PCL). The PCL is a band of tissue that crosses inside the center of the knee joint. It connects your thighbone to the bone of your lower leg. The PCL keeps your knee stable when it moves forward or backward.

A direct blow to the knee can injure your PCL. For example, the PCL can be injured in a car crash when your bent knee hits the dashboard. You can also hurt your PCL during sports, such as football, soccer or skiing. You can hurt it while doing other activities if you fall on your bent knee with your foot or toes bent downward, or if the front of your knee is hit.

A PCL injury can also happen if you stretch or straighten your knee beyond its normal limits (hyperextend the knee).

Common causes of PCL injuries include blunt force trauma, such as falling directly onto the knee or receiving a blow that compresses the joint. Rapid twisting or hyperextension of the knee can also lead to injury.

Athletes participating in high-impact sports like rugby, skiing, football or soccer are at higher risk of experiencing a PCL injury. Any activity that involves a risk of landing abruptly and awkwardly on the knee or overextending the joint increases the risk of injury. Age, poor conditioning or footwear with poor support increase risk.

Proper safety techniques while playing sports, such as wearing protective gear and adequately warming up before physical activity, are essential to prevent PCL injuries. Addressing any postural imbalances that may cause excessive strain on the joint is also crucial.

An injury to your PCL may cause swelling, pain, tenderness and stiffness around the knee. Several hours after the injury, your pain may get worse, and moving your knee might be harder. You may also have bruising and feel unstable, like the knee may give out.

The doctor will examine you and ask questions about your medical history. You’ll also be asked how you injured your knee and what your symptoms were at the time of the injury. Your doctor will thoroughly examine your knee and leg, checking for swelling and gently pressing on specific areas to identify the most tender spots. Next, your doctor will move your knee and leg in various ways to assess stability. They will also examine the rest of your leg to ensure proper blood flow and functionality and that there are no other injuries above or below the knee. You may need tests such as an X-ray or a magnetic resonance imaging (MRI) scan to confirm the diagnosis.

Your treatment will depend on the severity of your injury and whether other parts of your knee are injured.

• Mild or grade one injuries and moderate or grade two injuries may only need home treatment under the direction of a doctor. Many people can be active again after four to six months. The following are often suggested for recovery:
  • Apply ice or a cold pack to your knee for 10 to 20 minutes. Do this every one to two hours during waking hours for the first three days after your injury or until the swelling goes down. Put a thin cloth between the ice and your skin.
  • Prop up your leg on a pillow when you ice it or anytime you sit or lie down. Do this for about three days after your injury. Try to keep your knee above the level of your heart. This will help reduce swelling.
  • Take anti-inflammatory medicines to reduce pain and swelling. These include ibuprofen (Advil, Motrin) and naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
  • Follow your doctor’s recommendation about how much weight you can put on your leg and how to walk with crutches, if applicable.
  • Wear a brace to protect and support your knee while it heals if your doctor recommends it. Wear it as directed.
  • Do stretches or strength exercises as your doctor suggests.
• Severe or grade three injuries may require crutches and wearing a hinged knee brace. After about nine months, many people are able to be active again. A severe tear may need surgery. But this usually isn’t done unless you also injure other parts of the knee, such as the medial collateral ligament (MCL) or meniscus.

Your doctor may recommend physical therapy to increase your range of motion and strengthen your muscles. Our experts at the Montefiore Einstein Department of Physical Medicine and Rehabilitation will create an individualized treatment plan to help with recovery, symptoms and repair.