Posterior Cruciate Ligament (PCL) Tear

What is a Posterior Cruciate Ligament (PCL) Tear?

The PCL (posterior cruciate ligament) connects the shinbone to the thigh bone and keeps the shinbone forward of the thigh bone. The PCL is located inside the knee around the knee joint and is behind the ACL (anterior cruciate ligament).

PCL injuries are usually incurred while directly hitting or falling on the knee while it is bent. PCL injuries can also occur when severe torquing of the knee occurs.  Many athletes and those who are physically active have PCL injuries. It can also happen during an auto accident or blunt force trauma.

At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, we take our time with each patient to listen and present options that are customized to their specific needs. Dr. Charles E. Stewart specializes in PCL reconstruction and repair.

Knee Ligaments 

  1. Collateral Ligaments

Collateral ligaments control sideways movements of the knee. These two ligaments are located on the inside and outside of the knee. The medial is on the inside and the lateral is outside the knee joint.

  1. Cruciate Ligaments

Cruciate ligaments control the knee’s back-and-forth motions and prevent rotational movements. These ligaments are located on the inside of the knee joint and as mentioned previously, form an “X” with the anterior ligament in the front of the knee and the posterior behind.

Types of PCL Injuries:

Doctors classify PCL injuries into four grades. PCL issues can be either acute or chronic. Acute PCL conditions result from an accident or injury. Chronic PCL injuries develop and linger over time due to an injury. Both chronic and acute PCL injuries can progress if left untreated.

  • Grade 1: Partial tear
  • Grade 2: Partial tear with some instability and pain caused by stretching and loose PCL fibers
  • Grade 3: Complete tear, instability and pain
  • Grade 4: Complete tear with other damage to the knee and surrounding tissues

Posterior Cruciate Ligament (PCL) Tear Symptoms: 

Depending on the severity of the injury, PCL tear symptoms can range from mild to extensive. If there are other ligament injuries or tears, the symptoms may be wide-ranging.

The following symptoms are common with PCL tears:

  • Knee pain
  • Swelling and inflammation
  • Difficulty walking
  • Tenderness to touch
  • Knee joint instability 
  • A sensation of wobbling and being off balance in the knee
  • Difficulty bearing weight on the knee


Posterior Cruciate Ligament (PCL) Tear Causes:

The causes of PCL injuries and tears can vary depending on the patient’s age, overall health and activity level. Below are a few common causes of PCL injury:

  • Motor vehicle accidents (bent knees hit dashboard)
  • Contact sports (tackles, direct hit when the knee is bent)
  • Hitting shins with or on an object
  • Knee torquing and over-extension

Risk Factors for Posterior Cruciate Ligament (PCL) Tear Condition

What puts patients at greater risk of PCL tears or injury?  PCL tears can happen to anyone at any age, but mostly occur in younger teens or adults who are very active or play sports.  The following are a few examples of what might put individuals at high risk:

Certain sports increase the risk of PCL tears, including football, basketball, soccer, and gymnastics. However, PCL tears and injuries often result from getting hit in the knees or falling on the knees. Individuals with balance issues or careers that involve a higher likelihood of falls also face increased risk factors for PCL injury.

For individuals who have other knee injuries, the weakness in the knee joint can cause a greater risk for PCL tears. 

How a Posterior Cruciate Ligament (PCL) Tear is Diagnosed

The onset of pain, swelling, stiffness and instability will be a clear sign that something is wrong with the knee. Seeking medical care is crucial. The earlier PCL Tears are diagnosed and treated, the better the outcome for the patient.  

Along with a physical examination, orthopedic surgeons will also utilize diagnostic testing, which may include X-rays, magnetic resonance imaging (MRI) and ultrasound.

Posterior Cruciate Ligament (PCL) Treatment

Depending on any other coexisting knee injury, the health of the patient and the age of the patient, treatment may vary. PCL tears will not heal on their own and require surgery to rebuild it with grafted tissue and to close the ligaments back together; however, for the elderly and patients who live inactive lifestyles, conservative treatment may be sufficient. This includes resting, icing, elevating, bracing, physical therapy, pain medications and limiting weight-bearing.

Doctors recommend surgical intervention for complete PCL tears that cause ongoing instability. Grafts are often taken from the patient’s tendons, from the hamstring or quadriceps, etc. These will help to rebuild the PCL and new tissue will naturally grow over time and cause it to become more stable.

PCL tear repairs are usually performed via arthroscopic surgery. Arthroscopic surgery is a minimally invasive procedure utilizing tiny instruments through small incisions that is under fluoroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the knee joint. 

With decades of experience, at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine all of our surgeons are board-certified and fellowship-trained. We offer you the best treatment options and care.

We provide excellent medical care in a warm, caring, comfortable environment, where patients are treated efficiently, effectively and as if they were the only patient. Let us get you back in your game.