eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Posterior Cruciate Ligament Injury: Treatment & Medication

Author: Jawad Bhatti, MD, Consulting Staff, Departments of Internal Medicine and Physical Medicine and Rehabilitation, Catahoula Parish District Hospital
Coauthor(s): Stephen Kishner, MD, Residency Program Director, Professor of Clinical Medicine, Department of Medicine, Section of Physical Medicine and Rehabilitation, Louisiana State University School of Medicine; Mahmoud Sarmini, MD, Department of Medicine, Section of Physical Medicine and Rehabilitation, Assistant Professor, Louisiana State University School of Medicine
Contributor Information and Disclosures

Updated: Jul 10, 2008

Treatment

Rehabilitation Program

Physical Therapy

The top priority in the rehabilitation of posterior cruciate ligament (PCL) injury is the restoration of knee function to normal or to as close to normal as possible.

The treatment of PCL injury depends on the grade of the injury. An isolated injury of grade I or grade II may be treated with physical therapy.8 A grade I or grade II injury is usually treated with a brief period of knee splinting in extension, followed by early ROM and a quadriceps and hamstring strengthening program (that is particularly eccentric).9,10,11,12,13 Recovery is quick, and many patients are able to return to normal function in about 4 weeks. Closed kinetic chain exercises and open kinetic chain exercises are recommended. The use of continuous passive motion (CPM) machines for early knee mobilization is an option. A good outcome is correlated with the maintenance of good quadriceps strength.

The postoperative protocol includes the use of a knee brace in extension, with weight bearing as tolerated for 4 weeks, as well as the use of quadriceps strengthening exercises. Later, closed chain exercises are performed at 6 weeks, and proprioceptive training is carried out at 12 weeks. Hamstring exercises are delayed for 4 months to decrease the posterior load on the tibia. Patients can begin light jogging at 6 months. Cycling and aerobic exercise can also benefit the patient and can help to restore function.

With a multidisciplinary approach and the use of various modalities, such as ice and heat therapy, a good outcome is expected. Weight training and proprioceptive techniques also show good results in rehabilitative treatment.

Medical Issues/Complications

Patients with chronic posterior cruciate ligament (PCL) injury can develop medial compartment osteoarthritis and patellofemoral osteoarthritis of the knee. Arterial injury is possible during PCL reconstruction.

Surgical Intervention

Grade III posterior cruciate ligament (PCL) injuries may need surgical intervention. Tibial avulsion fractures with a PCL injury also require such intervention.9,14 Because of the complexity of biomechanical tensions, reproducing the function of the PCL complex is difficult.15,16,17  

Suture repair of insertion site avulsions is effective if it is performed less than 3 weeks after the injury. Nonabsorbable sutures are placed through the avulsed ligament and tied over the bone bridge. Unfortunately, the results are often unsatisfactory.

Other surgical techniques can rely on a single or a double reconstruction technique. In the single bundle reconstruction technique, a hamstring patellar tendon or Achilles allograft is passed through the tibial tunnel into the femoral tunnel in single bundle technique. Studies have shown that this technique can result in an improvement in the patient's symptoms. In one study, statistically significant improvement (P = .001) from the preoperative condition was found at 2- to 10-year follow-up evaluations.18

In the double bundle reconstruction technique, 2 femoral patellar tunnels are used to recreate the functional activity of the 2 bands in the injured PCL. Two grafts are placed. A larger anterolateral graft is placed at 90º of flexion. A posteromedial graft is placed in knee extension to provide posterior stability.19

Consultations

An orthopedic surgeon should be consulted for grade III posterior cruciate ligament (PCL) injuries or for poorly recovering grade II injuries.

Other Treatment

If patients who develop knee pain are willing to try acupuncture treatment, this therapy may be considered. However, data do not show long-term relief from acupuncture use. More research into this modality, including the conduction of double blind, placebo-controlled studies, is needed.20 Studies have shown that transcutaneous electrical nerve stimulation (TENS) units and ultrasonographic treatment are effective in pain management.21

More on Posterior Cruciate Ligament Injury

Overview: Posterior Cruciate Ligament Injury
Differential Diagnoses & Workup: Posterior Cruciate Ligament Injury
Treatment & Medication: Posterior Cruciate Ligament Injury
Follow-up: Posterior Cruciate Ligament Injury
References
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References

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Further Reading

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Keywords

posterior cruciate ligament injury, PCL injury, ligamentum cruciatum posterius, knee ligament, tibia, medial condyle, femur, hyperextension, knee laxity

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Contributor Information and Disclosures

Author

Jawad Bhatti, MD, Consulting Staff, Departments of Internal Medicine and Physical Medicine and Rehabilitation, Catahoula Parish District Hospital
Jawad Bhatti, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, and American College of Physicians-American Society of Internal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen Kishner, MD, Residency Program Director, Professor of Clinical Medicine, Department of Medicine, Section of Physical Medicine and Rehabilitation, Louisiana State University School of Medicine
Stephen Kishner, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Mahmoud Sarmini, MD, Department of Medicine, Section of Physical Medicine and Rehabilitation, Assistant Professor, Louisiana State University School of Medicine
Mahmoud Sarmini, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and International Society of Physical and Rehabilitation Medicine
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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