Posterior Cruciate Ligament Injury - Causes, Symptoms, Diagnosis, and Treatment

What Is a Posterior Cruciate Ligament Injury?

The strongest ligament in the knee is called the posterior cruciate ligament (PCL). It reaches the bottom-front surface of the femur, a bone that extends from the pelvis to the knee, from the top-rear surface of the tibia (the bone between the knee and ankle). The tibia cannot move too far and end up behind the femur because of this ligament.

A posterior cruciate ligament injury is the partial or total tearing or straining of any portion of the posterior cruciate ligament (also known as a hyperextended knee). The posterior cruciate ligament is typically hurt when the knee is extended too much (hyperextension). This may occur if someone jumps and lands incorrectly. A direct hit to the flexed knee, such as when someone falls heavily on a bent knee, can also injure the posterior cruciate ligament. The majority of posterior cruciate ligament injuries also involve other ligaments and serious knee damage. The nerves and blood vessels are frequently hurt, and the knee is frequently dislocated.

It is crucial to consult a doctor as soon as possible if an individual thinks they might have suffered a posterior cruciate ligament injury. One should get tested for these other conditions as soon as possible because posterior cruciate ligament injuries frequently occur with other ligament injuries or serious knee damage.

What Causes a Posterior Cruciate Ligament Injury?

The most common cause of posterior cruciate ligament injuries is a hit to the knee when it is bent. The posterior cruciate ligament may become harmed in many ways, including:

• The knee gets abruptly forced backward by anything, such as a vehicle accident.
• The shin collides violently with something, perhaps the dashboard of a car.
• An abrupt action causes the knee to twist or overextend.
• The foot is pointed downward when one lands on their bent knee after falling or being tackled. While participating in sports like football or soccer, this may occur.

Sports injuries to the posterior cruciate ligament are rather prevalent. These injuries are particularly prevalent in the following:

• Football.
• Soccer.
• Baseball.
• Skiing.

Damage from a posterior cruciate ligament injury can range from minor to severe. Posterior cruciate ligament injuries are divided into the following groups:

• Grade I: There is a partial tear in the posterior cruciate ligament.
• Grade II: The ligament is looser than in Grade I and is partially ruptured.
• Grade III: The ligament is ripped, causing instability in the knee.
• Grade IV: The posterior cruciate ligament and another knee ligament have been injured.

Posterior cruciate ligament issues can be sudden or gradual. An abrupt injury is the cause of acute posterior cruciate ligament issues. An injury that progresses over time is what causes chronic posterior cruciate ligament issues.

What Are the Symptoms Observed in Posterior Cruciate Ligament Injury?

The following are the typical signs of a posterior cruciate ligament injury:

• Swelling and constant pain follows the injury, both fast and persistently.
• Swelling causes the knee to lock up and could result in a limp.
• Having trouble walking.
• The knee feels shaky and as though it might ‘give out.

How to Diagnose Posterior Cruciate Ligament Injury?

1. Medical Examination

The doctor will inquire the patients about their symptoms and medical background on their initial visit.

2. Physical Inspection of the Body

The doctor will inspect all the structures in the injured knee during the physical examination and compare them to the structures in the uninjured knee. When bent, the injured knee could seem to sag backward. When bent past a 90-degree angle, it is particularly vulnerable to sliding back too far.

3. Imaging Examinations

X-rays and magnetic resonance imaging (MRI) scans are two additional tests that could assist the doctor in confirming the diagnosis. But it is conceivable for these pictures to look normal, particularly if the damage happened more than three months before the examinations.

• X-rays - The posterior cruciate ligament will not be visible on X-rays, but they can reveal whether the ligament tore a piece of bone when it was ruptured. An avulsion fracture is what this is. To determine how far back the shin bone can slide, the doctor may additionally request stress views.

• Magnetic Resonance Imaging (MRI) - Soft tissues, such as the posterior cruciate ligament, can be visualized more clearly with an MRI scan than with an X-ray.

How to Treat Posterior Cruciate Ligament Injury?

1. Non-Surgical Therapy: If the posterior cruciate ligament is the only part of the damage, surgery might not even be necessary. The doctor might suggest non-surgical approaches for treatment:

• RICE - The RICE method, which entails rest, ice, mild compression, and elevation, helps hasten recovery when an individual is initially hurt.

• Immobilization - To stop the tibia bone from sagging backward, as gravity tends to pull the bone in a backward direction when one is lying down, the doctor may advise wearing a specific brace. Individuals can be given crutches to prevent them from putting weight on their legs to further protect their knees.

• Physical Therapy - Individuals will start a comprehensive rehabilitation regimen as soon as the swelling subsides. Their knee will regain function as a result of certain workouts, and the leg muscles that support it will grow stronger. It has been demonstrated that a critical element in a speedy recovery is strengthening the quadriceps muscles, which are located in the front of the thigh.

2. Surgical Therapy: Surgery might be advised by the doctor if one has many injuries. For instance, surgery is nearly always required if the knee has dislocated and many ligaments, including the posterior cruciate ligament, have been damaged. Patients who have an isolated posterior cruciate ligament injury may also gain from rebuilding if they experience ongoing instability or pain that does not subside after non-operative care.

• Rebuilding a New Ligament - A torn posterior cruciate ligament is frequently rebuilt since stitching the ligament ends back together seldom heals the injury. The doctor will use a tissue graft to repair the torn ligament. Most frequently, this graft is taken from another area of the patient's body or a human donor (cadaver). The graft may need several months to integrate into the bone. Small incisions are normally used during surgery to repair a posterior cruciate ligament; however, some surgeons may still need to create an additional incision on the side of the knee. Traditional open surgery is more intrusive than arthroscopic surgery. Less intrusive procedures are advantageous because they hasten healing times after surgery and reduce postoperative pain. The surgical techniques used to restore posterior cruciate ligaments are getting better. After rehabilitation, more sophisticated procedures enable patients to continue a greater variety of activities.

• Rehabilitation- Whether or not surgery is part of the treatment plan, rehabilitation is essential to bring an individual back to their regular activities. Patients can regain knee strength and motion with the aid of a physical treatment regimen. Physical therapy would start one to four weeks after the operation if individuals underwent one. The extent of the posterior cruciate ligament injury will determine how long it will take for it to heal. Although healing from combined injuries is frequently protracted, most patients eventually recover satisfactorily. If the injury requires surgery, it can be weeks or even months before one can resume working at a desk job, especially if their position requires a lot of physical activity. It normally takes six to 12 months to heal fully. Even though rehabilitation takes time, dedication to therapy will make a big difference in the ability to eventually resume all of an individual's favorite activities.

Conclusion:

Posterior cruciate ligament injuries can be painful and crippling, but with the right care, they can be properly cured. Physical therapy and paying attention to the doctor's advice will help an individual recover more quickly so they can get back to their normal routine.