PCL Tear

What a PCL tear is

The posterior cruciate ligament runs from the front of the thigh bone backward and downward to the back of the shin bone, behind the anterior cruciate ligament. Its role is the opposite of the ACL's: it stops the shin bone sliding backward relative to the thigh bone, and it contributes to rotational control. It is a broad, strong ligament, and PCL injuries occur less often.

The classic mechanism is a blow to the front of the shin while the knee is bent, driving the shin bone backward. That happens in motor vehicle collisions, where the knee strikes the dashboard, and in contact sports and falls onto a bent knee with the foot pointed down. Hyperextension can also injure it. Unlike the ACL, PCL injuries are frequently partial rather than complete, and partial tears have the potential to heal, which is one reason management differs. The PCL may also be torn as part of a multi-ligament injury, together with the structures at the outer corner of the knee, and those combined injuries are treated differently.

Symptoms that often bring people in

• Pain and swelling at the back of the knee after a fall or a blow to the front of the shin
• A vague sense that the knee is loose, often less dramatic than with an ACL tear
• Difficulty on slopes or stairs, or discomfort kneeling
• Aching at the front of the knee or around the kneecap over time
• A knee that seems to sag backward when at rest and bent

How it is evaluated

Because symptoms can be subtle, PCL injuries are sometimes recognized late. Examination compares the resting position of the shin bone on the two sides with the knees bent, and includes tests in which the surgeon pushes the shin backward to see how far it travels. The outer corner of the knee, the collateral ligaments and rotational stability are checked as well, since combined injuries change the plan. X-rays are used to look for fractures and for bone pulled away with the ligament, and MRI to confirm and grade the injury. In longstanding cases, standing views may be used to assess alignment.

Treatment options in general terms

Many isolated PCL injuries are managed without surgery, with rehabilitation at the center. It may include:

• Early protection. A brace that supports the shin bone from behind and limits backward sag while the ligament settles.
• Quadriceps-focused rehabilitation. Strengthening the muscles that resist backward movement of the shin bone.
• Graded return to activity. Progressing loading and sport-specific work as control improves.

Surgery is generally reserved for particular situations, and may be discussed when:

• The injury is high grade or combined. A PCL tear alongside other torn ligaments.
• A bony avulsion is present. The ligament has pulled a fragment of bone away, which may be reattached.
• Instability persists. Symptoms continue despite committed rehabilitation, in which case reconstruction with a graft may be considered.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada and has a background in orthopedic trauma as well as sports injury, which matters because PCL injuries often arise from higher-energy events. A consultation covers how the injury happened, an examination of the whole knee rather than the PCL alone, review of imaging, and whether rehabilitation or surgery fits your situation. Second opinions are welcome.

This page provides general information about PCL tears and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

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