Performed by – Khalid Al-Hourani, Alastair Davidson, Reza Mansouri, Zuhair Nawaz, Andrew Perry, James Singleton

The Posterior Cruciate Ligament links the tibia (shin bone) to the femur (thigh bone). It is situated in the middle of the knee and is important in controlling movement of the two bones, particularly during sport. The PCL is typically damaged during sporting activity by forcing the tibia backwards when the knee is flexed at 90 degrees.

Reconstruction of the Posterior Cruciate Ligament (PCL) of the knee is not required as often as ACL reconstruction. Usually PCL injuries do well with physiotherapy but when the knee remains unstable, an operation may be required.

Diagnosis of PCL Injury
The diagnosis depends on a clinical examination at which time the laxity of the PCL and any other ligaments can be assessed. An MRI scan will also usually be done to assess the severity of the PCL injury and to see if the meniscal cartilages are also damaged. Only the more severe injuries need surgery. Partial injuries can generally be treated with physiotherapy and achieve a good functional result with return to high level sports.

What Happens at surgery?
The operation requires a general or spinal anaesthetic and one night in hospital. The procedure involves excising the damaged PCL and replacing it with a graft of your own tissues. Most of the operation is done through keyholes but there is also one 3 cm incision below the knee.

The surgeons at Joint Reaction prefer to use a hamstring graft. In this technique 2 tendons from the inside of your knee are removed via a 3cm incision below the kneecap. Despite the loss of these tendons your hamstring strength will return to almost normal after rehabilitation.

The graft is inserted into the knee via tunnels drilled in the bone of the tibia and femur and is secured with screws in these tunnels.

In many cases other structures can be injured at the time of a PCL rupture. Frequently a reconstruction of the tissues on the postero lateral aspect of the knee needs to be done at the same time.

After the operation
The knee will be swollen and uncomfortable for a week or two. You will need to wear a hinged brace, which will be locked straight for the first fortnight and after that will start physiotherapy to get the knee bending. For the first month, we will recommend only passive bending (ie, with your physio carefully assisting, without you actively trying to make the knee bend). After that, from six weeks onwards, the exercises will progressively increase so that by 3 months post-op you should be walking well without help or a limp. We would not recommend any high impact sports until at least 6 months have passed.

Outcome
As it takes more force to rupture the PCL than the ACL and because other structures in the knee may have been damaged, the outcome from PCL reconstruction may not be as good as after ACL reconstruction. Osteoarthritis may occur and although the knee should feel stable, you may not be able to return to as vigorous sporting activity as before the injury.