What is Arthroscopic PCL Reconstruction?

The Posterior Cruciate Ligament (PCL) is a primary stabilizing ligament of the knee, preventing the tibia from going backward in relationship to the femur. People can tear their PCL as a result of severe trauma to the knee. The usual mechanism is one in which the tibia bone is forced backward such as when hitting your tibia against a fixed object during a hard fall (ie. a snowboarder landing hard on a rail in the terrain park). It is not uncommon to tear other ligaments in the knee when one tears their PCL.

Not all PCL tears require surgery. However, complete PCL tears resulting in severe knee instability often require arthroscopic PCL reconstruction surgery. In this surgery, a tendon graft is placed in the knee exactly where the original PCL attached. Arthroscopic surgery is less invasive than open surgery, with a shorter recovery time. It can effectively stabilize the knee and alleviate pain so that patients can resume sports and other activities. Dr. Cunningham is a knee surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating PCL tears for patients in Vail, Summit County, Aspen, and Denver, CO.

When is PCL Surgery Necessary?

PCL tears are graded on a I-III scale depending on severity:

  • Grade I – Low grade partial tear of the PCL with less than 5mm of increased laxity
  • Grade II – High grade partial PCL tear with 5-10mm of increased laxity
  • Grade II – complete PCL tear with greater than 10mm of increased laxity.

Unlike ACL tears, PCL tears can heal if the diagnosis is made soon after the injury and the patient is placed in a knee brace holding the knee in extension. By holding the knee in extension, the knee remains aligned and there is no distracting force on the PCL, allowing it to partially or fully heal back together. In addition, grade I and II PCL tears may not result in enough symptoms to warrant PCL reconstruction surgery. However, grade III PCL tears and high grade PCL tears associated with a knee dislocation where multiple other ligaments are torn (ie. LCL, MCL, ACL, and/or posterolateral corner tears) most often require surgery as the knee is very unstable.

How is PCL Reconstruction Performed?

Patients undergo a nerve block immediately before surgery in order to help with postoperative pain. They then undergo a general anesthetic. Small incisions or portals are made to allow for access to the knee. The torn PCL is removed and the native attachment sites on the femur and tibia are marked. At these attachment sites sockets are made in the bone. A tendon graft (typically a large donor tendon) is then seated into these bone sockets. The graft is tensioned and fixed securely within the bone sockets. Any other associated ligament tears are reconstructed and any meniscus tears repaired. The incisions are closed and dressed. The lower extremity is placed in a hinged brace with the knee held straight, which protects the reconstructed PCL.

How Long Does PCL Reconstruction Surgery Take?

Arthroscopic PCL reconstruction surgery takes 2-3 hours. This surgery is longer than ACL surgery as the attachment sites are harder to visualize and reach. Moreover, great care must be taken during PCL surgery, as vital nerves and blood vessels are directly adjacent to the PCL. Patients can go home the same day after isolated PCL reconstruction. However, if the PCL and multiple other ligaments require reconstruction, then a patient is kept overnight for observation.

How Long is the Recovery After PCL Reconstruction?

A complete recovery from a PCL reconstruction can take 9 – 12 months. If other repairs are required, the recovery can be 12 months or more. A general guideline for recovery is as follows:

  • Weeks 1-4: Initial post-surgical period. The knee is iced and elevated. The knee is locked in extension in a hinged brace. Gentle physical therapy is started. The patient is kept on crutches with no weight bearing on the knee.
  • Weeks 4 – 12: Range of motion is progressed to full. Weight bearing is allowed with the knee in extension until 8 weeks. The knee brace is discontinued at 8 weeks. Gentle strengthening is started.
  • Weeks 12- 18: Biking and pool exercises are allowed. Strengthening exercises are progressed.
  • Weeks 18-24: Patients are allowed to run. Strengthening is progressed. More demanding movements are started.
  • Months 6-12: Full strength is achieved. Cutting and pivoting sports are allowed after passing a sports test in Physical therapy. This can often take 12 months from surgery.

Depending on individual injury patterns, PCL reconstruction typically results in a high degree of patient satisfaction with a return to sports and activities. Dr. Cunningham is a knee surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and surgically reconstructing PCL tears for patients in Vail, Summit County, Aspen, and Denver, CO.

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