PCL Tear

Many isolated PCL injuries—especially Grade I and II—can be treated non-surgically with excellent outcomes.

RICE Protocol

• Rest: Limit weight-bearing activities. Range of motion exercises encouraged when able to reduce stiffness
• Ice: Apply 15–20 minutes at a time, several times daily to reduce swelling.
• Compression: Use elastic wraps or sleeves.
• Elevation: Keep the leg elevated to reduce swelling acutely

Bracing

• A PCL-specific hinged knee brace helps protect the ligament, to allow healing, and prevent backward motion of the tibia.
• Some braces allow for gradual increase in motion while maintaining stability.

Physical Therapy

• Focus on:
  • Strengthening the quadriceps to compensate for the injured PCL
  • Improving range of motion
  • Enhancing proprioception (balance and joint awareness)
• Avoid hamstring strengthening early on, as it can place stress on the healing PCL.

Return to Activity

• Recovery time varies by injury severity.
• Grade I: 2–4 weeks
• Grade II: 4–8 weeks
• Grade III: Often longer and may require surgery

Surgery is usually recommended for:

• Grade III tears (complete ruptures) with significant instability
• PCL tears associated with injuries to the ACL, MCL, LCL, or meniscus (multi-ligament knee injuries)
• PCL tears with bone avulsion (ligament pulls off part of the bone)
• Chronic PCL deficiency with ongoing instability or damage to cartilage
• High-level athletes or physically demanding occupations

The standard surgical approach for a PCL tear is reconstruction. This involves replacing the torn PCL with a graft.

PCL Reconstruction Procedure

• Performed arthroscopically (minimally invasive)
• Bone tunnels are drilled in the femur and tibia
• A graft is passed through these tunnels to replicate the original ligament
• The graft is fixed with screws or buttons to hold it in place

Graft Options

Autograft (from the patient’s own body):

• Hamstring tendon or quadriceps tendon

Allograft (donor tissue):

• Preferred in revision cases or when large grafts are needed

PCL surgery requires a dedicated rehab process and close follow-up:

0–6 Weeks

• Use of a brace and crutches
• Early controlled motion exercises
• No weight bearing or limited weight bearing to protect the graft

6–12 Weeks

• Gradual progression to full weight bearing
• Continued strength and motion exercises

3–6 Months

Strengthening, balance training, and sport-specific drills

6–12 Months

• Return to full activity and sports
• Clearance based on strength, function, and passing functional tests

Nonoperative Outcomes

• Most patients with isolated Grade I or II PCL injuries do very well with conservative care.
• May return to sports or physically demanding activities within weeks to a few months.
• Long-term outcomes are generally good if the knee remains stable.

Surgical Outcomes

• 85–90% of patients experience improved stability and function
• Athletes often return to sports, though some may need 9–12 months of recovery
• Best results occur with early diagnosis, experienced surgical technique, and proper rehab
• Outcomes for isolated PCL reconstructions are better than for multi-ligament injuries

Risks of Surgery

• Stiffness or loss of motion
• Graft failure or stretching
• Nerve or vascular injury (rare)
• Infection
• Need for additional procedures

• Untreated or poorly managed PCL injuries can lead to chronic knee instability, meniscus tears, or arthritis
• Some patients with longstanding PCL deficiency may develop posterior sag and joint degeneration over time
• Early intervention and rehabilitation are key to optimal results

Seek prompt medical care if:

• You sustain a blow or fall on a bent knee
• You feel the knee shift, buckle, or give out
• There is persistent swelling or pain
• Your knee feels unstable or cannot support your weight
• You’ve been diagnosed with a PCL tear and have not improved after conservative treatment