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Posterior Cruciate Ligament(pcl) Tear

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PCL is located at the back of the knee. It runs from the top surface of the tibia diagonally into the large notch at the end of the femur. PCL prevents tibia from sliding backwards under the femur, giving stability to the knee.

How common: PCL tears are much less frequent than ACL tears. They are rare as an isolated injury and more commonly occur in a multi-ligament-injured knee.

Average patient: A 28-year-old kabaddi player who takes a tackle below the knee.

Cause: Blunt trauma to the front of the shin (tibia), driving it backward. This could be from a contact injury during high-energy sports, the knee hitting the car dashboard in an accident, or falling on a flexed knee.

Symptoms: Acute PCL injuries lead to immediate onset of pain and swelling. In case of isolated PCL tears, the swelling subsides eventually. Pain around the kneecap or behind the knee on bending, and instability (lack of confidence) remains.

What to do: Be aware of the signs of an emergency. Gross instability, numbness and tingling, gross malalignment (leg pointing in the wrong direction), and inability to bear weight are all signs that need immediate evaluation.

Severity of injury: PCL tears are similar to ACLs: they are graded 1 to 3 based on amount of damage, with grade 3 being a complete tear.

Treatment options: Conservative (non-operative) therapy including rehab and bracing is offered for almost all isolated PCL tears. Surgery is reserved for those with complete PCL tears with associated (ACL or MCL or PLC) injuries, bone avulsions of the PCL tibial attachment, athletes who require good knee stability, those who have failed conservative treatment, or those with unacceptable residual instability.

Expected result: PCLs can heal well on their own in the right patient; however, complete tears often heal loose. Outcomes of surgery are varaiable depending on technique and surgeon. As surgical sewing of the ligament ends does not heal, a torn PCL must be rebuilt with a tissue graft. This graft is taken from another part of your body and fixed at the original PCL site using mini-incisions (arthroscopy).

Return-to-activity timeline: Recovery is dependent on the availability of a functional brace. Patients using the brace are back to walking within 6-8 weeks of surgery or conservative treatment. The other option involves using a knee-extension brace after acute injury or surgery and restricting weight bearing for 6-8 weeks. ROM and strengthening exercise are gradually increased to achieve normalcy in 3-4 months. It usually takes 9-12 months for the ligament to be healed enough to return to sports.

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