PCL Tear Treatment
Management of posterior cruciate ligament injuries using rehabilitation or surgical treatment when appropriate
What is PCL tear treatment?
The posterior cruciate ligament runs from the back of the shin bone up into the middle of the knee, and its job is to stop the shin sliding backwards under the thigh. It is thicker and stronger than the ligament in front of it, and it takes a considerable force to tear.
The classic mechanism is a direct blow to the front of a bent knee. A dashboard in a road accident, a fall onto the front of the knee, or a tackle that drives the shin backwards all do it. Because the force is high, the ligaments at the back and outer corner of the knee are often damaged in the same moment.
Unlike the front cruciate, this ligament has a blood supply and a partial tear can heal in place if the shin is held forward while it does. That is why many are managed without an operation and why the brace matters as much as anything else.
What you might notice
- Pain at the back of the knee
- A knee that gives way or locks
- Knee pain that will not settle
- Trouble with stairs or standing up
How it is diagnosed
The examination is done with the knee bent to ninety degrees and both knees compared side by side. Your surgeon looks along the shins from the side: the injured shin sits further back, and they then push and pull it to measure how far it travels compared with the good leg. That difference is graded, and the grade drives the plan.
An MRI confirms it and, more importantly, shows what else went. The corner ligaments, the meniscus and the cartilage surfaces are all checked, because an isolated tear and a multi-ligament injury are managed quite differently.
X-rays are taken to look for a fragment of bone pulled off with the ligament, and stress views may be added later to measure the laxity objectively once the swelling has gone.
Recovery
The first phase is about protecting the healing ligament. A brace that supports the shin from behind is worn for several weeks, often full time, and it is there to stop gravity pulling the shin backwards while you sit and sleep.
The quadriceps is the muscle that substitutes for this ligament, and rebuilding it is most of the treatment. Expect three to four months of supervised work, front-loaded with straight-leg and inner-range exercises that protect the ligament while loading the muscle. Hamstring work is limited early on, because those muscles pull the shin in the direction the ligament is trying to resist.
After a reconstruction the timeline is longer. Crutches and a brace for six weeks, a gradual return to running at around four to six months, and pivoting sport at nine to twelve.
If it is left untreated
An isolated, partial tear treated with a brace and serious muscle work often does well, and a good number of people go back to full activity without an operation. Watchful management is a reasonable first plan here in a way it is not for every ligament.
A complete tear left alone is different. The shin sits permanently backwards, which shifts the load onto the cartilage behind the kneecap and on the inner side of the joint. Over years that pattern of loading wears those two areas out, and arthritis in a young knee is a harder problem than the original injury.
When the corner ligaments are torn as well, leaving it alone is not advisable at all. Those injuries do not compensate, and the knee stays unstable in a way that muscle work cannot correct.
Questions about PCL tear treatment
Can a PCL tear heal without surgery?
Often, yes, and that is a genuine difference from the ligament at the front of the knee. This ligament has a blood supply and it sits in a position where the two torn ends can stay in contact, so a partial tear can knit if the shin is held forward while it does. That is the purpose of the brace, and it is why the brace is worn far more strictly than people expect. The other half of the treatment is the quadriceps muscle, which pulls the shin forwards and takes over some of the ligament's job. Three to four months of serious work on it is the standard first plan for an isolated tear.
Why do I need a special brace for this?
Gravity works against this particular ligament. When you sit or lie with the knee bent, the weight of the shin pulls it backwards, which is exactly the direction the torn ligament is meant to resist, so an ordinary hinged brace does nothing useful. A PCL brace has a pad or a spring that pushes the top of the shin forwards continuously and holds the torn ends together. It is usually worn day and night for the first several weeks, including in bed, and taken off only for washing and for the exercises you have been given. Wearing it inconsistently is the commonest reason a tear that should have healed does not.
When can I go back to sport?
For a tear managed with a brace and rehabilitation, running usually returns at around three months and full sport at four to six, provided the shin no longer sags on examination and your thigh strength is within about ten per cent of the other leg. After a reconstruction the timeline is longer, with running at four to six months and pivoting sport at nine to twelve. In both cases the decision is made on tests instead of on dates. Your physiotherapist will measure strength and put you through hop and landing tests, and going back before those are passed is the main reason people injure the knee again.
Other orthopaedics treatments
Replacement of a damaged knee joint to relieve persistent pain and improve mobility when conservative treatment is no longer enough
InpatientAssessment and treatment of ACL injuries, with rehabilitation or reconstruction considered based on activity and instability
InpatientTalk to a care coordinator about PCL tear treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one