There are four major ligaments associated with the knee joint: two cruciate ligaments and two collateral ligaments. The posterior cruciate ligament (PCL) works together with the anterior cruciate ligament (ACL) to limit the forward and backward movement of the tibia (shin bone) in relation to the femur (thigh bone). While the PCL is approximately the size of one’s pinky finger, it is the strongest of the four main knee ligaments. The powerful structure of the PCL lends to its capability of withstanding large amounts of stress; however, this ligament is still susceptible to injury from a sizeable force applied to the front of the knee. Although athletes involved in contact sports are the most likely to experience a PCL injury, non-athletic individuals are also capable of damaging the PCL from a fall directly onto a bent knee or in a motor vehicle collision. Dr. Frank McCormick, orthopedic knee specialist serving Orlando, West Palm Beach County, and surrounding Florida communities, has the knowledge and understanding, as well as substantial experience, in treating patients with a PCL injury.
Yes. There are three different grades of a posterior cruciate ligament (PCL) injury that is assigned based on the severity of ligament damage. In a Grade 1 PCL injury, the ligament is stretched or pulled but is not severely damaged. A Grade 2 PCL injury results in mild instability of the knee joint when a portion of the ligament is torn away from its attachment site. A Grade 3 PCL injury is given when the ligament ruptures into two separate pieces resulting in moderate to severe instability of the knee joint.
There are several events, such as a work or sports-related injury, chronic knee joint use, or a traumatic event, that can damage the knee cartilage. A traumatic event can force the knee joint out of its normal position producing a knee joint dislocation. The natural aging process can cause cartilage tissue degeneration over time. Degeneration of the knee cartilage can also occur when the body’s own immune system attacks this tissue. The cartilage can become partially or completely separated from the bone in the event of a violent or abnormal twisting motion. Lastly, a penetrating injury of the knee cartilage can cause bacteria to infiltrate the knee joint leading to an infection of the knee cartilage.
A posterior cruciate ligament (PCL) injury rarely occurs in isolation due to the substantial force needed to damage this ligament; therefore, this injury is likely to be accompanied by damage to other knee joint structures. Individuals with suspected PCL injuries commonly complain of pain and swelling along the outside of the knee, particularly with increasing speed while running. Difficulties with mobility such as walking downstairs, slowing down with running, and/or pivoting on the affected lower leg have also been reported. A classic indicator of a PCL injury is difficulty with lifting the front portion of the foot, also known as “foot drop”. Prompt medical attention should be sought from an orthopedic knee specialist as “foot drop” is concerning for peroneal nerve damage.
Dr. McCormick will begin by gathering an in-depth medical history, including prior knee injuries, underlying medical conditions, and current symptoms, followed by a thorough physical examination. Diagnostic imaging studies, such as x-rays and magnetic resonance imaging (MRI), to further evaluate the extent of damage to the posterior cruciate ligament (PCL) and rule out damage to any other knee joint structures.
If damage is isolated to the posterior cruciate ligament (PCL) only, conservative treatment options may be adequate in healing a PCL injury. Considerably limiting or avoiding weight-bearing altogether can help protect the PCL while it heals. Implementing a combination of rest, ice, compression, and elevation (RICE) with non-steroidal anti-inflammatory medications (NSAIDs) can diminish any pain and inflammation associated with this joint condition. A physical therapy program aimed at improving the overall functionality of the knee joint can be particularly beneficial in repairing a PCL injury. To make participation in this physical therapy program more tolerable, Dr. McCormick may consider injecting a corticosteroid directly into the knee joint.
Surgical intervention is often needed for posterior cruciate ligament (PCL) injuries, especially when accompanied by damage to other knee joint structures. Patients that failed to respond to conservative treatment measures are also good candidates for surgical repair. A tendon graft, either from the patient (autograft) or donor tissue (allograft), is used to surgically reconstruct the PCL. Dr. McCormick favors the minimally invasive surgical technique to position the tendon graft as close to the native PCL as possible and secure it in place with special surgical anchors. The tendon graft has a higher rate of success when situated overlapping the native PCL.
For more information on meniscus tears of the knee, or the excellent treatment options available, please contact the office of Frank McCormick, MD, orthopedic knee specialist serving Orlando, West Palm Beach County, and surrounding Florida communities.
