Are there varying degrees of a posterior cruciate ligament injury?
The criteria for grading posterior cruciate ligament (PCL) injuries involve assessing the severity of damage and classifying them into three categories:
- Grade 1 injury: Shows minimal damage from the ligament being pulled or stretched.
- Grade 2 injury: Occurs when the ligament is stretched beyond its limits resulting in a partial tear from the attachment site.
- Grade 3 injury: Results in knee joint instability from a complete rupture of the ligament into two separate pieces.
What are the symptoms of a posterior cruciate ligament injury?
Because of the amount of force needed to cause damage to the posterior cruciate ligament (PCL), it is rarely the only knee ligament affected in a traumatic event. Individuals with a suspected PCL injury report pain and instability of the knee. Swelling of the affected knee can also occur especially with continued physical activity. Some other common symptoms of a PCL injury can include difficulties with certain movements such as:
- Twisting or pivoting the affected lower leg
- Walking downstairs or slowing down on a run
How is a posterior cruciate ligament injury diagnosed?
A comprehensive medical history, with a focus on prior knee injuries and conditions, will be gathered through an interview with Dr. Patel. A thorough physical examination will follow involving a series of orthopedic tests to assess stability of the affected knee and careful testing of all knee ligaments. Diagnostic imaging studies are particularly useful for suspected posterior cruciate ligament (PCL) injuries. X-rays can identify if any bone-related damage occurred as a result of the precipitating injury. Magnetic resonance imaging (MRI) can identify the extent of damage to the PCL as well as evaluate the surrounding soft tissue structures for any additional damage.
What is the treatment for a posterior cruciate ligament (PCL) injury?
If the posterior cruciate ligament (PCL) was the only ligament that sustained damage, conservative therapies may alleviate any associated symptoms. Avoiding or limiting weight-bearing can prevent further injury to the knee joint. A combination of RICE (rest, ice, compression, elevation) and non-steroidal anti-inflammatory medications (NSAIDs) is encouraged for pain and inflammation management. Participating in a physical rehabilitation program is crucial for repairing damage to the PCL.
More often, however, there is damage to other ligaments or structures of the knee joint which necessitates surgical reconstruction of the posterior cruciate ligament (PCL) and all other ligaments to properly restabilize the knee joint. A minimally invasive arthroscopic procedure involving a small camera (arthroscope) and specialized surgical instruments removes the damaged tissue fragments. If enough healthy tissue remains, the PCL is simply reattached in the correct anatomical position. A complete rupture of the PCL will often utilize a tissue graft, either from the patient (autograft) or donor (allograft), for new tissue to generate. This new ligament is passed through a tunnel within the head of the tibia and fastened to the femur with special surgical anchors.