PCL Tear/Reconstruction

What is it?

Ligaments are tough, nonstretchable fibers that hold your bones together. The PCL is similar to the ACL in that it connects the thigh bone (femur) to the shin bone (tibia). These two ligaments hold your knee together. If either is torn, you may experience pain, swelling and a feeling of instability. The PCL is larger and stronger than the ACL and is less often torn.

PCL injuries commonly occur from a direct blow to the knee while it is bent. Most people do not feel or hear a pop. Symptoms tend to develop over a period of time and include pain, swelling, instability and trouble putting weight through the leg.

Injuries to the PCL can be classified into four grades:

Grade I: The PCL has a partial tear.
Grade II: The ligament is partially torn and is looser than in Grade I.
Grade III: The ligament is completely torn and the knee becomes unstable.
Grade IV: The PCL is damaged along with another ligament in the knee.

To properly diagnose your doctor may order any of the following imaging tests in addition to the physical examination performed: x-ray, MRI or arthroscopy. An arthroscopy is a surgical technique that allows the doctor to see inside the knee through the use of a tiny camera inserted through a small incision.

What are the treatment options?

If the injury is mild, rest, ice, compression and elevation are an effective treatment option. Over-the-counter pain medications can be useful in relieving pain and reducing swelling. If the injury is severe surgery may be needed to reconstruct the ligament.

You can recover from some posterior cruciate ligament injuries without surgery. This includes more acute grade I or II injuries in which no other ligaments are injured as well as new diagnosed chronic injuries that aren’t causing symptoms.

You will most likely be prescribed to go to physical therapy where you will receive exercises that will help strengthen the muscles around the knee. Rehabilitation may include, using crutches at first, then gradually walking with more weight through the leg; temporarily wearing a brace for support; having a therapist help you stretch the knee; strengthening the thigh and hip muscles to make the knee more stable; and eventually progress to sport specific training if appropriate.

Patients who may be more likely to need surgery include those who have PCL injuries with which bone has also become loose, injuries involving more than one ligament or injuries which cause instability especially in athletes.

Surgery for a torn PCL requires replacing it with new tissue rather than stitching together the torn ligament. The ligament may be replaced with tissue from a deceased donor or a piece of tendon moved from somewhere else in the body, such as the back of the thigh or heel. If a piece of bone is torn off, the surgeon may fasten the bone back into place using a screw.

The operation is sometimes done as an "open" surgery. This requires a large incision in the knee.

A less-invasive option involves a tool called an arthroscope. The surgeon uses smaller incisions.

After surgery, the length of time needed for rehabilitation can range from 26 to 52 weeeks.

Procedure Goals

The goal of PCL reconstruction is to restore ligamentous stability to the knee and allow for return to previous level of function.

Risk Factors

This injury is more common in men than in women. Participating in contact sports such as football and soccer may also increase your risk of a posterior cruciate ligament tear.

Depending on how many structures in the knee were damaged you may experience long term knee pain and instability. You may also have an increased risk of developing arthritis in the knee.

As with any surgical procedure potential risks include bleeding and infection at the site of incision. Other risks specific to PCL reconstruction include knee pain and/or stiffness, poor healing of the graft and failure to achieve symptom relief.

What to Expect

Before Procedure

It is likely that you will go through physical therapy for a few weeks before surgery. The goals of attending physical therapy pre-operative include reducing pain and swelling, restoring the knee’s full range of motion and strengthening the muscles. Meeting these goals will assist with a better healing process post-operative including restoration of full range of motion.

Day of Surgery

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

You will discharge the same day of your surgery. Before you go home you will practice walking with crutches and you may have to wear a knee brace or splint to help protect the knee. You will be told whether or not you can put weight through your leg.

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Knee Care & Bathing

• Use your crutches and do not place any weight on your operated leg! This is important!
• Keep your knee elevated above heart level as much as possible for the first 48 hours, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing.
• Keep your splint clean and dry all the time.
• It is ok to shower or sponge bathe 2 days after surgery but you must keep your splint clean and dry at all cost! This usually entails wrapping your knee in a plastic garbage bag to keep it dry.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
• It is not necessary to use ice while sleeping.
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
• No driving while taking any narcotic pain medication!
• The pain medication may cause some nausea so take it with food.
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling in the knee, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
• Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125. 

Rehabilitation Plan - Exercises

Following your surgery and prior to your first post-op visit, the following exercises are very important in order to restore your knee motion and maintain muscle function. Your rehab program will be advanced at your first post-op visit with your surgeon and physical therapist. Use the ice machine as instructed or as often as possible, especially before moving the knee. Crutches and immobilizer or brace (locked straight) should be used at all times while walking. You may put as much weight on the leg as is comfortable unless otherwise instructed.

Exercises:

1. Seated Extension Stretch: Open the immobilizer or brace and place a rolled towel under your heel to allow your knee to stretch into full extension. Restoring normal extension is very important and needs to be addressed now. Perform this 2-3 times a day. 10-15 minutes each session. You may and should use ice during this session.

2. Seated Quad Set: With the leg straight and immobilizer open, place a rolled towel under your knee and tighten the quad muscles in the front of the thigh, pushing the knee down into the towel. Perform this 2-3 times a day. 25-30 reps each session.

3. Ankle Pumps: Move your ankle up and down frequently during the day. This will help the circulation in the calf and decrease lower leg swelling.

4. Heel Slides: To bend your knee, begin with sliding your heel towards your buttocks as far as you can into your pain tolerable range, then slide back down straight. When you can put your feet up on the wall, you can begin wall slides. Rest the operative leg on the non-operative leg, then lower the feet down the wall, allowing gravity to bend your knee. Use your non-operative leg to push your feet back up the wall. Repeat several times during a 10-15 minute session. Do this 2-3 sessions a day.