The posterior cruciate ligament (PCL) is one of two cruciate ligaments found at the back of the knee. PCL injury is rare as they are one of the stronger ligaments in the knee. Rarely occurring in isolation, PCL injuries tend to be accompanied by injuries of other ligaments or the meniscus.
There are 2 ways in which PCL reconstruction can occur, these are:
Open tibial inlay technique: an open tibial inlay technique, is not typically preferred as it raises concerns of post-surgical complications, such as risk to the neurovascular structures, and increased operating room time.
Your orthopaedist will recommend an arthroscopic PCL reconstruction if:
An acute PCL reconstruction surgery is necessary. Acute in this context means the conservative approach to recovery is not considered. Reconstruction surgery is non-negotiable when patients have incurred a 3rd-grade injury which involves a complete tear or rupture of the ligament or if there is evidence of multi-ligamentous injury.
The conservative approach provides no relief of symptoms. If 2nd-degree injuries show no improvement and pain progresses.
Patients specify a desire to return to sports or athletic endeavours; patients that are athletes tend to seek treatment with the quickest recovery rate.
How does PCL reconstruction work?
Following the assessment, a graft selection – tissues used to reconstruct PCL structures, is made. Options for types of graft include autografts (harvested from one's own body), and allografts (obtained from a donor).
Two or three small incisions are made at the knee and an arthroscope is inserted, allowing your orthopaedic surgeon to visually assess the condition of your knee through the camera. This phase of the procedure is also known as arthroscopic diagnosis.
Next, the preparation of grafts is conducted. The procedure will vary depending on the type of graft which was obtained. Following the preparation, bone tunnel placements will be made to create space for graft fixtures. On top of addressing PCL reconstruction, other injuries that may have occurred such as ACL or meniscus injuries will also be addressed during the surgery.
The surgical site is then irrigated to prevent infections before it is closed either by suture or staples.
What results can I expect from PCL reconstructions?
PCL surgeries are complex with various reconstruction techniques required, however, the success rate for PCL surgery is around 85%. This indicates that a high recovery rate is evident and regaining pre-injury strength and stability is likely. Athletes with goals to return to sports activities too, have a high probability with a current reported success rate of 80-91%.
The recovery process varies for everyone depending on the type of PCL injury incurred. Generally, it takes a longer time to heal from PCL injury, this factor is attributed to the fact that PCL is a large ligament and in comparison, a much stronger ligament than others. For a third-grade injury to occur in the first place, it would have taken significant damage, justifying the length of recovery.
It can take up to 12 months for complete recovery and return to daily activities.
Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.
How many treatment sessions are needed?
PCL arthroscopic surgery is a one-off treatment. The only variation is the time it may take in the operating theatre especially when multiple injuries are sustained.
Treatment for PCL injury does not stop at surgery. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers. The frequency of physiotherapy sessions will vary according to your personal goals such as the need to return to athletic endeavours.
Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.
Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.