Posterior Cruciate Ligament Tear

The posterior cruciate ligament (PCL) is a tough band of tissue in the knee that connects the shin bone (tibia) to the thigh bone (femur). The PCL helps to keep the knee stable. A PCL tear is an injury in which the PCL stretches or tears.

What are the causes?

This condition is caused by stretching the PCL too far. It can happen if you:

• Fall onto the top of your shin bone while your knee is bent.
• Quickly and forcefully straighten or bend your knee more than normal.

What increases the risk?

This condition is more likely to develop in people who play sports such as football, soccer, skiing, and hockey because those sports involve:

• Running and changing directions quickly (cutting).
• Playing on uneven surfaces.
• Direct contact with other players.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain deep in the knee or behind the knee. Pain may get worse when you run, squat, or use stairs.
• Swelling.
• Bruising.
• Stiffness.
• Tenderness.
• Feeling unstable or like your knee will give way, especially when on uneven ground.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Imaging tests, such as:
  • An X-ray. This may be done to check for bone injuries.
  • MRI. This may be done to see if your ligament tore all the way through.

During your physical exam your health care provider will test your knee to see if it moves more than it should.

How is this treated?

This condition may be treated by:

• Resting your knee.
• Avoiding activities that cause pain or swelling.
• Keeping your weight off your leg until pain and swelling improve.
• Applying ice to the knee. This helps with pain, stiffness, and swelling.
• Taking an NSAID. This helps to reduce pain and swelling.
• Wearing a knee brace. This helps to support your knee and keeps the PCL from stretching.
• Doing range-of-motion, strengthening, and stretching exercises. These may be recommended after pain and swelling improve.

If your symptoms do not improve with these treatments or if other ligaments were also damaged, you may need to have surgery. Surgery usually involves replacing the ligament.

Follow these instructions at home:

If you have a brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.

Managing pain, stiffness, and swelling

• If directed, apply ice to your knee.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your foot often to avoid stiffness and to lessen swelling.
• Raise (elevate) your knee above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.
• Ask your health care provider when it is safe to drive if you have a brace on your leg.

General instructions

• Do not use the injured limb to support your body weight until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• Your symptoms are not improving.