What is the posterior cruciate ligament?
The knee is stabilized by four main ligaments: 2 collateral ligaments (medial and lateral) and 2 cruciate ligaments both anterior
(front) and posterior (back). The cruciate ligaments attach to the
femur (thigh bone) and travel within the knee joint to the upper
surface of the tibia (shin bone). The ligaments pass each other in the
middle of the joint forming a cross shape, hence the name 'cruciate'.
The posterior cruciate ligament (PCL) functions mainly in preventing
the tibia from traveling backwards on the femur, known as posterior
drawer. It also helps to prevent the tibia from twisting outwards.
Injury to the ligament leads to knee instability with the shin bone
having a tendency to 'sag' backwards when the knee is bent at 90
degrees.
How is the posterior cruciate ligament injured?
The incidence of injuries of the PCL is less than that of the anterior cruciate ligament.
This is mainly due to the greater thickness and strength of the PCL.
Nevertheless, the most common way in which the PCL is injured is by
direct impact to the front of the tibia itself, usually when the knee
is bent. This may occur in a front-on tackle or collision or when
falling with the knee bent. The injury is commonly associated with
injuries to other structures in the rear compartment of the knee joint
such as lateral meniscus tears. In addition the articular cartilage may also be damaged.
PCL
tears are graded I- III with III being the most severe. These gradings
are classified depending on the amount of backward tibial displacement
observed when the knee is bent at 90 degrees. In extreme cases the
ligament may become avulsed, or pulled off the bone completely.
Symptoms of a posterior cruciate ligament injury:
- Pain at the time of impact which, over time, may also be felt in the calf region.
- Swelling, although this may be minimal (video).
- Pain when the posterior cruciate ligament is stressed (video).
- Positive sign on the 'Posterior draw test'.
- Pain and laxity when a 'reverse Lachman's test' is performed.
- Instability of the joint, perhaps associated with the feeling of the knee 'giving way.
Treatment for Posterior Cruciate Ligament Sprain:
What can the athlete do after sustaining a PCL injury?
What can a professional do?
- A
sports injury professional will firstly firstly aim to correctly
diagnose the injury. This may be achieved by performing specific tests
such as the 'posterior drawer test' or 'revese Lachman's'. - Referral for an MRI scan and/or X-ray to assess the extent of the damage.
- Operate - surgery for posterior cruciate ligament.
Once the injury has been correctly diagnosed, 2 modes of treatment may be recommended:
1. Conservative Treatment
This is indicated in most PCL injuries and may consist of:
- Ice and heat treatment.
- Electrotherapy e.g. TENS and Ultrasound
- Manual therapy treatments
- Advise
on a specific rehabilitative exercise program which may include:
quadriceps and hamstring strengthening, gait reeducation and balance
training using wobble boards.
2. Surgical Treatment
A
lesser proportion of PCl injuries require surgical intervention.
However in more serious cases, in particular those in which other
structures within the knee joint have been injured, surgery
may be recommended. Surgery may also be indicated if the conservative
management has not aided the stability of the knee sufficiently over a
period of time.
In general, those
who have sustained a PCL injury normally have good recovery rates, with
most being able to return to sporting activities at the same level as
before the injury. However, full recovery from cruciate ligament damage
is highly dependant on the ability to adhere to a strict rehabilitation
program.
Surgeon Mr Richard Villar talks to sportsinjuryclinic.net about surgery for the posterior cruciate ligament. | 
It also helps to prevent the tibia from twisting outwards.
ReplyDeleteMeniscus surgery