An injury to the PCL, or posterior cruciate ligament, is known as “the dashboard injury,” because it is most commonly caused by a car accident that causes the bent knee to strike the dashboard with great force. The other way a PCL tear can happen is from a fall onto the front of the knee that causes it to bend all the way backward.
The PCL is one of the four ligaments that supports and stabilizes the knee and prevents excessive movement. The cruciate ligaments (there are two) control the back and forth bending of the knee. The PCL is located inside the knee joint, and is the strongest of the four supporting ligaments.. It is also the least likely to tear, representing only about 20% of all ligament injuries. So, it is not uncommon to see other tears, damage to cartilage and fractures bones along with the PCL.
Symptoms of a PCL Tear
Similar to other knee ligament injuries, a PCL tear causes pain, swelling, decrease in range of motion, difficulty walking, and sometimes, a feeling that the knee is unstable and may give out or buckle.
Grading of PCL Tears
PCL tears are considered sprains and are graded by severity.
- Grade I Sprain: Partial PCL tear. The ligament has been damaged but it still functions to keep the knee joint stable.
- Grade II Sprain: Partial tear of the PCL without other ligament injury. The ligament has been stretched to the point where it is now loose and no longer stabilizing the knee joint effectively.
- Grade III Sprain: Complete tear of the PCL combined with other ligament injury. The ligament has been completely torn into two pieces and the knee joint is unstable.
Treatment for PCL Tears
Grade I and Grade II PCL sprains are usually treated conservatively with rest, ice, compression, and elevation. Many physicians recommend using crutches or a walking stick to allow you to keep weight off the knee. Once the swelling and pain subside, you will likely begin physical therapy.
In a Grade III tear, in which other ligament injuries are involved, surgery is sometimes recommended. Because of the location of the PCL, however, surgery is difficult, and orthopedic surgeons differ in opinion as to whether surgery is helpful.
The cruciate ligaments cannot be sutured together, but require a graft, which is taken either from one of the patient’s own tendons (autograft) or from a cadaver (allograft). The graft is inserted using an arthroscope. These grafts may stretch out over time and lose function. Surgery is only recommended for the most severe injuries that include injury to more than one of the structures of your knee and cause severe restriction.
Rehabilitation and Recovery
If you have surgery, expect to be out of work for several weeks if you have a sedentary job, or several months if your job requires a lot of physical activity. It will take anywhere from 6 to 12 months to achieve a full recovery.
Some possible complications of PCL surgery include:
- Contracting deadly viral diseases from the graft, including HIV and hepatitis C
- Loss of sensation, weakness or paralysis in the leg or foot
- Blood clots in the veins below the knee
- Pulmonary embolism from a blood clot breaking loose and traveling to the lung
- Stroke from a blood clot traveling to the brain
- Instability or stiffness in the knee
- Ruptured tendon at the site where the graft was taken
- In children, growth plate injury is possible
- Continued pain in the knee
Making a Claim
If you have been injured in a car accident or a fall and have suffered a severe PCL tear, you can expect to rack up substantial medical costs and to be out of work for quite some time. If the accident was another person’s fault, you may have a claim to recover compensation you for your injuries, time out of work and pain and suffering.
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