PCL repair or reconstructive surgery is surgery on the posterior cruciate ligament (PCL), which runs on the back of the knee, crossing the anterior cruciate ligament (ACL) in an X shape. These injuries are relatively rare and difficult to detect, as they are on the back of the knee, and occur most often during sports or other high-impact activity. PCL surgery on its own is rarely performed, unless other ligaments are torn and a combined reconstruction/repair surgery is necessary.
PCL reconstruction surgery uses a graft to replace the ligament. Typically, the grafts come from your own body and include tissue taken from the kneecap tendon or one of the hamstring tendons. Other good choices include allograft tissue (donor tissue). On the other hand, PCL repair surgery sews the ends of the torn ligament back together.
Most PCL repair surgery is done by reconstructing the PCL, since reconstruction typically leads to better results than repair surgery. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this case, the bone fragment connected to the PCL is reattached to the bone. PCL repair surgery is done by making small incisions in the knee and inserting instruments through these incisions (arthroscopic surgery) or by creating a large incision in the knee (open surgery). In either case, regional or general anesthesia can be used. PCL surgery is typically done on an outpatient basis.
Who is a candidate?
Candidates for PCL repair or reconstruction surgery generally have experienced a direct and severe blow to the front of the knee (as is common in contact sports). There may be a pulling or unnatural stretching of the ligament, and a simple misstep hinders further movement. More often than not, orthopedic surgeons recommend nonsurgical treatment for PCL injuries, as the outcomes from both are variable, and surgery will not necessary lead to more improvement than continuous physical therapy.
Who is not a candidate?
Candidates who have a partially torn PCL, but no symptoms of pain/instability or other combined knee injuries are not good candidates for PCL surgery. The vast majority of patients with a torn PCL will not see greater benefits from arthroscopic or open-knee surgery over nonsurgical management.
Additionally, children whose growth plates are still open or anyone with a severe illness or infection are not good candidates. Nonsurgical and less invasive treatments such as a hinged knee brace or physical therapy may help restore the stability of the knee and reduce pain.
Like other surgeries, PCL repairs require certain general surgery protocol such as preoperative blood testing, and cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Arthroscopic surgery is done on an outpatient basis, while more invasive surgery may require a multi-day hospital stay. Immediately after your procedure, your doctor will prescribe medication for pain relief and possibly a blood thinner to lessen the risk of blood clots. In the first few days after surgery, keep your leg elevated and apply ice to relieve swelling and prevent further inflammation. Ensure your incisions are kept clean and dry, and follow your surgeon’s instructions in regards to bathing, changing the dressing, and follow-up visits.
You can expect to return to normal activities in 4-6 months. Most patients use crutches for the first few weeks to avoid excessive pressure to the joint. It will be necessary to undergo a formal physical therapy program or regimen of knee-strengthening exercises and make take several months to a year. Physical therapy and rehabilitation will help restore motion and strengthen your leg and knee muscles.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. It is difficult to perform PCL surgery without damaging the neurovascular structures in the area (back of the knee). Other known complications include nerve and blood vessel injury, blood clots, surgical scar area numbness, problems with the graft tendon (in the case of reconstructive surgery), or the need for additional revision surgery. Pain and swelling are expected and may persist in some form even with physical therapy, limiting future participation in athletic activities that require use of the knee.
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