Non-operative Treatment of PCL Injury

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Kim Jackson, Tony Lowe, Tarina van der Stockt and Jess Bell

Basic Structure and Function

The PCL is a very large ligament, located posterior to the ACL, comprised of 2 bundles:

1. Anterio-medial: taught when knee is in flexion
2. Posterio-medial bundle: taught when knee is in extension

Both bundles work synergistically to create stability within the knee.

Functions:

• PCL is the primary restraint to posterior translation of tibia relative to femur
• Secondary stabilizer resisting tibial external rotation as well as valgus/varus stresses

It often occurs in combination with other ligamentous damages.

The mechanism of injury involves some type of varus or valgus force in combination with posterior tibial force.

Decision making and physical Examination

Positive posterior drawer and posterior tibial sag signs are the most important tests to diagnose PCL and identify the management plan.

The decision regarding conservative or surgical management depens on the grade of injury and the associated soft tissue damage.

Grades:

• Grade I: 0-5 mm posterior tibial translation
• Grade II: 5-10 mm posterior translation
• Grade III: > 10 mm posterior translation

Surgery is indicated for:

• All grade III comined PCL and posterior lateral corner injuries. The combination of posterior laxity and rotational instabilty may lead to suboptimal outcomes as the joint fail to regain stability essential for an active work life or return to sport when returning to sports.
• Grade II and III isolated PCL failed conservative treatment reporting repeated instability and/or tibial shifitng with activities
• Multi-ligamentous injury

.Isolated PCL injuries, regardless of the grade, can be considerd for conservative treatment.