Return to Play
When nonoperative treatment has been initiated, the athlete may return to play once the quadriceps strength has been regained. Yearly follow-up is recommended to monitor the knee for degenerative changes. Athletes with PCL injuries that have been operatively treated may return to sports at 9-12 months following surgery, pending the course and compliance with physical therapy and also the return of quadriceps strength. Follow-up at 2, 6, 12, 24, 36, 48, and 52 weeks following surgery is recommended.
Prevention
Most cases of PCL injuries are not preventable. Athletes who participate in at-risk sports should maintain good strength and flexibility and should practice good techniques within their specific sports. Some physicians advocate the use of functional knee braces for reducing the risk of a recurring PCL injury when returning to activity.
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A normal lateral radiograph of a knee. In a normal knee, a line drawn along the posterior femoral condyle will not intersect the posterior tibial condyle.
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A lateral radiograph of a knee with a posterior cruciate ligament injury. Note that the same line as in the above image will bisect the posterior tibial condyle due to a posterior sag and an incompetent posterior cruciate ligament.
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The posterior tibial sag sign. The photo on the left demonstrates the clinical finding of the posterior tibial sag sign. A line drawn parallel to the patella accentuates the posterior tibial sag. The photo on the right demonstrates the quadriceps active drawer test described by Daniels. With the knee in 70-90° of flexion, the extensor mechanism is contracted, pulling the tibia anteriorly into a reduced position.
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A close-up view of a posterior tibial sag with an incompetent posterior cruciate ligament.
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This MRI of the knee shows a torn posterior cruciate ligament.
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This MRI (coronal section) shows a posterior cruciate ligament tear.
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This transverse MRI shows edema to the torn posterior cruciate ligament.
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A view of the broad origin of the posterior cruciate ligament (PCL) on the medial femoral condyle of a left knee. The anterior cruciate ligament has been removed for surgical reconstruction.
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An additional view of the posterior cruciate ligament broad origin and insertion in a knee pending anterior cruciate ligament reconstruction.
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A right knee pending posterior cruciate ligament (PCL) reconstruction. A minimal notchplasty is completed. Two guide pins are advanced into the medial femoral condyle for tunnel placement to reconstruct the 2 bundles of the PCL.
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The 2 tunnels are created by reaming from outside in; 8- to 9-mm tunnels are made depending on patient size and the graft that will be used.
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Two red Robinson catheters are advanced through the femoral tunnels.
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The catheters have premade holes, which are used for suture retrieval.
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The catheters are advanced and threaded out the posterior knee. In this case, a posterior tibial onlay graft from an Achilles tendon allograft is used. The 2 bundles are secured to the catheters and advanced into the joint through the tunnels.
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The 2 Achilles tendon bundles are secured with a baseball whipstitch, are threaded through the catheter holes, and are advanced into the femoral condyle tunnels.
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Additional view of the placement and advancement of the Achilles allograft.
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Completion and seating of the femoral allograft reconstruction. The 2 bundles are secured or stabilized by suturing over a post and washer. Note the reestablishment of the broad surface area for the reconstructed posterior cruciate ligament origin.
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Completion of the tibial onlay, 2-bundle Achilles tendon allograft/posterior cruciate ligament (PCL) reconstruction. The bony calcaneus remnant is secured to the posterior tibia with 1 or 2 interfragmentary compression screws into a trough into the posterior tibia at the level of the PCL insertion. Care is taken to not penetrate the anterior tibial cortex with these screws. Note the intact original anterior cruciate ligament.
