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The posterior cruciate ligament (PCL) is a tough band of tissue that connects your tibia (shin bone) to your femur (thigh bone). Along with the anterior cruciate ligament (ACL), it forms a cross between the bottom of the femur and the top of the tibia in the centre of the knee, which basically holds your knee together.An important job
The cruciate ligaments allow us to be active - to run, to jump and to swim. The problem is that during those activities, ligaments and tendons in any joints can be damaged and the resulting injury needs proper care to return these ligaments to top form. Generally, a posterior cruciate ligament injury will be less serious than an anterior cruciate ligament tear; however, it can still leave you on the sidelines for weeks or even months. Ligament injuries need proper care; unattended, they can lead to further problems, such as pain, weakness or instability in the joint. A PCL knee injury can even raise the chance of getting arthritis in the affected joint later in life.
A PCL tear is not as common as an ACL tear. Although the knee is one of the most common areas for injury during sports and activities, only about 20% of ligament damage is to the PCL. This is because it is thicker and tougher than the ACL. This also means, of course, that an injury that damages the PCL is likely to damage other ligaments.
The most common way of causing a PCL tear is to fall or hit your knee when your knee is bent. One common example is when your knee hits the dashboard of your car in an accident; another is a fall. Most people, however, manage to damage their ligaments while playing sports or taking part in outdoor activities.
Playing sports such as football or basketball, in addition to activities such as running or skiing, do run the risk of all types of injury and especially injury to the knee and ankle. This is understandable - you are moving quickly, twisting and turning, and shifting your weight very quickly. This may well put a strain on the ligament in itself and you are also more likely to have your knee bent at the moment of impact if you fall or are hit.
‘The pain’ might be an obvious response to this question! Falls and strains are a fairly common occurrence during any sport and not all of them result in a serious injury; however, you should be on the lookout for signs that you have more than a bruise or a mild strain. Torn ligaments require medical attention, and the sooner the better.
When someone suffers an ACL injury, they often hear a ‘popping’ sound or feel a ‘popping’ sensation. This is not usual for a posterior cruciate ligament injury; therefore, you need to look out for the following signs that your ligament is torn:
If you are in agony as soon as the injury occurs, you probably won’t need telling to head for the A&E department. Many people are not that badly hurt, at least at first. They go home, assume it is a minor injury and then realise that the knee is not getting any better. This is when you really need expert medical advice.
A doctor will check your knee for a posterior cruciate ligament injury using different methods. This will probably begin with asking you about the history of the injury. What were you doing? Was your knee bent, straight or twisted when it was injured? How did it feel, and what symptoms have you experienced since?
The doctor will then probably proceed to a physical examination. They will examine the way in which your knee bends, the tightness of your ligaments and observe you walking. This should reveal any looseness in the ligaments holding your knee together.
Both x-rays and magnetic resonance imaging (MRI) can also be used to determine the nature and extent of the PCL knee injury.
If you have a posterior cruciate ligament injury, the doctor will classify it into one of the following categories:
If you suspect that you have a posterior cruciate ligament injury, you can begin treatment at home using a method called PRICE. This involves:
Once you have been diagnosed by a doctor, there is more that can be done. Very serious PCL injuries require surgery to replace the torn ligament and to fasten any pieces of bone that have come loose back into place. This can be open surgery or performed using an arthroscope, which does not need such a large incision. After surgery, rehabilitation will take from 26 to 52 weeks.
Not all PCL tears will need surgery. Many grade 1 and grade 2 cases can be treated with physical therapy and non-invasive methods, such as supporting the joint for a period of time. This will involve wearing a knee brace to keep the joint stable and prevent further injury or stretching, and possibly the use of crutches or another walking aid.
Other treatments include movement therapy, where a machine or a therapist moves your leg through its range of motion; walking or running in a pool; walking or running on a treadmill; exercises to strengthen your thigh muscles, which will make the knee more stable; and specific sports training.
Once you have experienced a PCL tear, you don’t want another! If you have never had one, you would probably like to keep it this way. You can’t avoid knocks and bumps if you play sports, but you can make injury less likely in various ways.
Firstly, warm up properly - this is very important. Secondly, wear the appropriate safety gear. Sports such as mountain biking and skiing have a range of special gear for a purpose, which is your safety. If you think you need support, wear support. If you are playing a contact sport, follow the rules! Exercising to ensure that you are moving correctly is also important - you can put strain on your muscles if you move poorly, in addition to being more likely to fall over if your balance is out.
Finally, if you do get a PCL injury, look after it properly. Make sure that it is properly supported until it is fully healed and that you follow the advice of your doctor and your physiotherapist. Putting strain on a joint too soon - before it is fully healed - can undo all the good work and leave you with a painful, unstable knee joint and a much stronger chance of a recurring injury.