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Posterior Cruciate Ligament Repair and Reconstruction Surgery
Unlike the an ACL tear, when the tearing of a PCL is less severe, athletes usually undergo repair surgery. When the tear is severe, the athlete must be operated on to recover function and resume their activity in sports. The tear can be repaired by reattaching the torn fibers to each other. If there aren't enough fibers for reattachment, the PCL should be reconstructed.
PCL Reconstruction
The posterior cruciate ligament, or PCL, is one of the main ligaments in the knee and injury to this ligament may be seen in a variety of settings. In general, most partial or isolated PCL tears can be treated non-operatively because the PCL, with its synovial covering, has some ability to heal. However, surgical reconstruction is usually recommended for PCL tears that occur in combination with other ligament tears of the knee.
Indications
It is usually recommended that acute PCL tears in combination with and ACL, posterolateral corner, or MCL complex tears be reconstructed within the first three weeks of injury. In rare occasions, the PCL may be repaired when it occurs as a peel off or bone avulsion injury. In patients with chronic PCL injuries, who are symptomatic for pain and instability, reconstruction may be indicated. It is important in these chronic injuries that a workup for possible concurrent other ligament injuries, as well as an assessment of the extremity allignment, be performed.
Procedure
A variety of graft choices are available to surgeons that include autogenous patellar or quadriceps tendon with bone blocks, or hamstring tendons. In addition, patellar tendon or achilles tendon allografts (from donors) may be used. The main portion of the PCL which needs to be reconstructed is the anterolateral bundles. Arthroscopic assisted or open PCL reconstructions involve removing the remaining native PCL, with care to preserve the ligament of Wrisberg if it is intact.
Rehabilitation
Postoperatively, it is recommended that the patient remain in full extension for a period of 2 to 4 weeks for isolated PCL reconstructions. In multiligament reconstructions, the patient is often placed into a continuous passive motion (CPM) machine for range of motion. Patients are non weight bearing with quad sets and straight leg raises in the immobilizer only started the 1st postoperative day.
It is especially important for PCL reconstruction patients to not have any posterior sag of their tibia which would stretch out the graft. Pillows or other support under the tibia is required for the first two months after surgery. After 8 weeks, weight bearing is initiated and more active rehabilitation is started.
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