The posterior cruciate ligament (or PCL) is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.
The Posterior cruciate ligament is an intracapsular ligament along with the anterior cruciate ligament (ACL) because it lies deep within the knee joint. They are both isolated from the fluid-filled synovial cavity, with the synovial membrane wrapped around them. The PCL gets its name by attaching to the posterior portion of the tibia.
The Posterior cruciate ligament (PCL) is located within the knee joint where it stabilizes the articulating bones, particularly the femur and the tibia, during movement. It originates from the lateral edge of the medial femoral condyle and the roof of the intercondyle notch then stretches, at a posterior and lateral angle, toward the posterior of the tibia just below its articular surface.
Although each Posterior cruciate ligament is a unified unit, they are described as separate anterolateral and posteromedial sections based off where each section's attachment site and function. During knee joint movement, the ligament rotates such that the anterolateral section stretches in knee flexion but not in knee extension and the posteromedial bundle stretches in extension rather than flexion.
The function of the ligament is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. The posterior cruciate ligament is located within the knee. Ligaments are sturdy bands of tissues that connect bones. Similar to the anterior cruciate ligament, the posterior ligament connects the femur to the tibia.
Common causes of injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.
There are four different grades of classification in which medical doctor’s classify a Ligament injury:
• Grade I, the ligament has a slight tear.
• Grade II, the ligament is minimally torn and becomes loose.
• Grade III, the ligament is torn completely and the knee can now be categorized as unstable.
• Grade IV, the posterior cruciate ligament is damaged with other ligaments in the knee (ACL. etc.).
With these grades of PCL ligament injuries, there are different treatments available for such injuries.
Treatment
It is possible for the PCL to heal on its own. Surgery is usually required in complete tears of the ligament. Surgery usually takes place after a few weeks, in order to allow swelling to decrease and regular motion to return to the knee. A procedure called ligament reconstruction is used to replace the torn PCL with a new ligament, which is usually a graft taken from the hamstring or Achilles tendon from a host cadaver.
An arthroscope allows a complete evaluation of the entire knee joint, including the knee cap (patella), the cartilage surfaces, the meniscus, the ligaments (ACL & PCL), and the joint lining. Then, the new ligament is attached to the bone of the thigh and lower leg with screws to hold it in place. Surgery to repair the posterior cruciate ligament is controversial due to its placement and technical difficulty.
It is possible for the PCL to heal on its own without surgery when it is in Grades I and II. PCL injuries that are diagnosed in these categories can have their recovery times reduced by performing certain rehabilitative exercises.
Fernandez and Pugh (2012) found that following a PCL grade II diagnosis, a multimodal treatment that spanned over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and implementing an exercise program that emphasized in eccentric muscle contraction (lunges, 1-leg squats, and trunk stabilization) which proved to be an effective way to recover from the PCL injury.
For Grades III and IV, operative surgery is recommended or is usually needed. Grafts is the method when addressing PCL injuries that are in need of operative surgery. With grafts, there are different methods such as the tibial inlay or tunnel method.
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