POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION
Posterior Cruciate Ligament (PCL) is the one which connects the thigh bone and the leg bone inside the knee joint.
We know that the Anterior Cruciate Ligament (ACL) keeps the knee stable during pivoting (changing directions) activities. Similarly the PCL prevents the leg bone from displacing backwards during various activities.
How common is PCL injury?
The PCL injuries are not uncommon and its prevalence has been reported to range between 3% and 37% of patients with knee ligament injuries. However many PCL tears go unnoticed because a popping sound is not as distinctive as in ACL injuries and swelling is not severe in sports injuries.
What happens if the PCL is torn?
Patients with neglected PCL injuries may present with limited activity such as having difficulty in climbing slopes due to lethargy and pain in the front and inner areas of the knee rather than instability.
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Diagnosis of PCL Tear:
While physical examination can lead to the diagnosis of PCL tear, confirmation is usually by MRI scanning.
Do PCL tears need surgical correction? If so why?
Mild (grade1) and moderate (grade 2) tears of the PCL usually heals well and surgery is hardly necessary. But for severe (grade 3) tears and tears along with other ligament inluries (commonly the postero lateral corner tear)(Figure 4), surgery gives the best results. With out surgery a severe PCL injury can lead to early wear and tear of the knee joint, which causes pain and swelling. According to Clancy et al, wear and tear was observed in 80% of the patients who did not undergo surgery.
Is PCL reconstruction possible through key hole surgery?
Yes, we as a routine manage grade 3 PCL tears and combined ligament injuries throuh key hole surgery. Hamstring graft is the one used by us to reconstruct the PCL. Recent studies have shown that it is possible to achieve satisfactory outcomes with arthroscopic PCL reconstruction using Hamstrings tendon graft even in the long term.