Understanding posterior cruciate ligament (PCL) reconstruction

The knee is the largest joint in the human body. Playing an important role in our ability to move, as well as helping to support the weight of our body, a problem in the knee can have a significant impact on our lives.

The knee is strengthened and supported by a number of ligaments, bands of tough connective tissue which connect bones together. As the name suggests, the posterior cruciate ligament (PCL) is located at the back of the knee. It connects the femur (thigh bone) with the back of the tibia (the larger of the two bones in the lower leg, sometimes referred to as the shinbone). The PCL provides stability to the joint by limiting the amount the tibia is able to move backwards.

Should the PCL be significantly damaged, surgery may be needed to restore function and stability in the knee.  

Why might I need PCL reconstruction?

The PCL is not as easily injured as the other ligaments in the knee joint. It is most often damaged by a significant impact to the knee or by being pulled by excessive accidental twisting of the knee.

Many injuries to the PCL are mild and will heal naturally over time. Some injuries however are more serious and may require surgery to repair the damage. Often when the PCL is damaged, other injuries to the knee also occur. For example, a direct, strong blow to the knee while playing a contact sport may end up tearing multiple ligaments and dislocate the knee joint itself. For multiple injuries like this, surgery will almost certainly be required to restore adequate stability and function to the knee.

Where the PCL is torn, it is usually necessary to remove it completely and replace it with a graft taken from another part of your body.

The majority of PCL reconstructions are performed as day case procedures, although occasionally an overnight stay is required. Surgery to reconstruct the PCL is done using arthroscopy. This is a type of keyhole surgery used to examine, diagnose and treat problems affecting a joint.

Arthroscopy for PCL reconstruction is normally carried out under general anaesthetic, meaning you will not be conscious during the surgery. An anaesthetist will talk with you about the anaesthetic they will be using for the procedure, and if you have any queries at any time, they will be happy to help.

Once you have been given the general anaesthetic, the skin around your knee will be thoroughly cleaned using an antibacterial fluid, to reduce the risk of infection. The surgeon will make a small incision near the joint and insert a thin metal tube (known as an arthroscope) through this cut into the knee joint. The arthroscope contains a light source and a camera or lens at one end and allows the surgeon to see the inside of the joint clearly.  Sometimes sterile fluid may be added into the knee joint to improve visibility of the joint.

Using the arthroscope, the surgeon will examine the PCL as well as looking at the extent of any additional damage to the soft tissues, cartilage or bones in the joint. Should any damaged tissue or loose fragments be present inside the knee joint, the surgeon can make additional small incisions and insert very small surgical instruments through these cuts, in order to remove or repair the damage. They use a similar approach to insert and secure the graft that will replace your PCL.

Once they have successfully reconstructed your PCL, they will remove the arthroscope from the knee joint and close any cuts made during the surgery using stitches or special surgical tape. Your knee will then be covered with a sterile dressing to ensure it remains free of infection.

It is important to note that PCL reconstruction is a significant surgical procedure and it can take many months for the knee and new PCL graft to build up strength after surgery. While you are recovering, it is essential that sporting activities are not re-started too quickly. While this can be frustrating for keen athletes, it is essential to take things slowly in order to gain maximum benefit from the surgery.

All surgical procedures carry risks and the potential for complications. For PCL reconstruction these include:

  • Infection in the knee joint,
  • Bruising and swelling of the knee,
  • Damage to the nerves near the knee joint,
  • Tearing of the graft used to reconstruct the PCL,
  • Formation of a blood clot (known as a ‘deep vein thrombosis’ or ‘DVT’).

The above risks are intended as guidelines only and are not exhaustive. We always recommend that you talk with your consultant about potential risks and complications before you decide to have any surgery.

The consultant-led orthopaedic Knee Clinic at St Joseph’s has vast experience in carrying out reconstruction surgery of the PCL. Should you be experiencing increased pain and/or stiffness in your knee joint following an injury or impact to it, please contact us to arrange a consultation with one of our knee specialists.

They will expertly assess the cause of your pain and determine the best treatment option available for you.

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