The posterior cruciate ligament (PCL) is one of four ligaments making up the knee joint. It is located deep within the knee joint, just behind the ACL, where it stabilizes the articulating bones, particularly the femur and the tibia (shinbone), during movement. It is the strongest and one of the less commonly injured ligaments of the knee.
Though they account for more than 20% of reported knee injuries, injuries to the PCL are commonly missed and left undiagnosed. The ligament is most commonly injured when the knee is hyperflexed (bent all the way back) and there is a blow to the shin pushing it backwards, such as in a dashboard injury during a car collision. For most injuries, the PCL, with its synovial covering, can usually heal on its own without an operation. Surgical reconstruction of the PCL is controversial and technically difficult, making PCL surgery recommended only for complete tears and multiligament reconstruction.
A surgical procedure begins with a complete evaluation (via arthroscope) 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 torn PCL is replaced with a grafted ligament, which is attached to the bone of the thigh and lower leg with screws to hold it in place. The graft is usually taken from the patellar or quadriceps tendone (with bone blocks), or from hamstring tendons. It may also be taken from a deceased donor (allograft).
Surgery usually takes place after a few weeks of injury, in order to allow swelling to decrease and regular motion to return to the knee. Operations are usually done on an outpatient basis. Recovery usually takes 6-9 months with the aid of a protective knee brace, crutches, an immobilizer, and/or continuous passive motion (CPM) machine.