BONE TO PICK

The PCL, or posterior cruciate ligament, is one of the key stabilising ligaments in the knee. Although injuries to it are less common, they are important to understand.

WHAT IS THE PCL?

Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital. He is also a member of the Malaysian Arthroscopy Society( MAS).

Four major ligaments hold the knee joint together. Two of them, the ACL( anterior cruciate ligament) and the PCL, cross inside the knee. The PCL connects the thigh bone( femur) to the shin bone( tibia) and prevents the tibia from sliding backwards relative to the femur.

In everyday activities such as walking, climbing stairs, or squatting, the PCL quietly does its job in the background, providing stability and control.

The PCL is actually thicker and stronger than the ACL, which is one reason PCL injuries are less common.

HOW DO PCL INJURIES HAPPEN?

PCL injuries usually occur when a strong force pushes the shin bone backwards while the knee is bent. A classic example is a car accident in which the knee hits the dashboard, often called a“ dashboard injury.”

They can also occur during sports, particularly contact sports such as football or rugby, or from a fall directly onto a bent knee.

Unlike ACL injuries, which often happen without contact and are associated with a popping sound and immediate swelling, PCL injuries can be more subtle. Many patients can walk after the injury, which can delay diagnosis.

WHAT SYMPTOMS DO PATIENTS EXPERIENCE?

Symptoms of a PCL injury vary with the severity of the injury. Mild injuries may cause only slight

discomfort and swelling. More significant injuries can lead to pain, swelling, and a sensation of instability, particularly when walking downhill or going down stairs.

Some patients describe the knee as feeling“ loose” or as if it might give way, though this is often less dramatic than in ACL injuries. In chronic or untreated cases, patients may develop anterior knee pain or early arthritis due to altered knee mechanics.

HOW ARE PCL INJURIES DIAGNOSED?

Diagnosis begins with a careful history and physical examination. Specific clinical tests help us assess PCL stability. X-rays may be used to identify associated fractures. Still, MRI is the most reliable method for confirming a PCL injury and determining whether other knee structures are also damaged.

HOW ARE PCL INJURIES TREATED?

The good news is that many PCL injuries can be treated without surgery. Because the PCL has some capacity to heal and the knee can remain reasonably stable, non-surgical treatment is often effective, particularly for isolated injuries.

Non-operative treatment usually includes physiotherapy to strengthen the quadriceps, which helps compensate for the injured ligament. A brace may be used

initially to support the knee during healing.

Surgery may be recommended for severe injuries, particularly when a PCL tear is associated with other ligament injuries or when the patient remains unstable despite adequate rehabilitation.

PCL surgery involves reconstructing the ligament with a graft and requires a structured rehabilitation programme afterwards.

WHAT IS THE RECOVERY LIKE?

Recovery depends on the severity of the injury and the treatment approach. Nonsurgical recovery may take several weeks to months, while surgical recovery can take 9 to 12 months before returning to high-level sports.

With appropriate treatment and rehabilitation, most patients achieve good function and return to their normal activities.

FINAL THOUGHTS

PCL injuries are less common than ACL injuries but should not be overlooked. Early assessment, accurate diagnosis, and appropriate rehabilitation are key to a successful outcome.

If you have ongoing knee pain or instability after an injury, it’ s important to seek specialist advice. Your knee is a remarkable joint, and with the right care, it can often recover well.- The HEALTH