POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION
The posterior cruciate ligament (PCL) is one of the four major ligaments in the knee. The ligament runs along the back of the knee from the end of the femur (thigh bone) to the top of the tibia (shin bone). The PCL is the strongest ligament in the knee, and the primary role of the PCL is to provide stability in multiple different planes. The PCL is particularly important in providing stability to the knee during activities involving pivoting and bending the knee.
Some patients who sustain a Grade III tear (complete tear) with instability of the knee require surgical intervention. The goal of PCL surgery is to stabilize the knee and prevent abnormal motion of the tibia bone. Surgery is also designed to prevent arthritis (many patients with PCL instability develop arthritis). The most reliable way to restore stability is to use a graft (healthy tissue from another location) to reconstruct the PCL. If a reconstruction is performed, Dr. Welch can use either healthy tissue from a donor (allograft tissue) or from the patient’s own body (autograft). Dr. Welch uses a minimally invasive, arthroscopic technique to perform the procedure. The new tissue must be placed in the right position in the knee and must be tensioned appropriately to restore stability to the knee.
Following surgery, patients are placed in a special PCL brace that stabilizes the knee. Range of motion is initially limited to full extension and then 0-90 degrees of passive motion starting four weeks after surgery. Dr. Welch recommends starting physical therapy two weeks after surgery. Physical therapy focuses on reducing swelling in the knee and restoring strength to the knee, with particular emphasis placed on the quadriceps. Dr. Welch recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities only after the patient has achieved certain goals (for example, appropriate quadriceps strength, appropriate range of motion, etc.). Most patients start sport-specific training approximately 4-6 months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.