Posterior Cruciate Ligament (PCL) Repair

Pronounced: pos-tea-ree-or kru-shee-ate lig-a-ment

Definition

Posterior cruciate ligament (PCL) surgery is the repair of a ligament in the knee. When possible, the torn ligament fibers are reattached to each other. The addition of tendon or other tissue may be needed to reconstruct severely damaged ligaments.

Posterior Cruciate Ligament

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Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

The PCL is one of the ligaments that connect the lower leg bone to the thigh bone. It helps to stabilize the knee during movement. PCL surgery is done to repair or replace the ligament after it is torn.

PCL surgery may be considered if:

  • The PCL is disconnected from the bone (avulsion)
  • The injury affects:
    • The ability to move around or take part in activities (especially in athletes)
    • How well the knee moves
  • The injury affects more than one ligament in the knee
  • Other treatment methods fail

Possible Complications     TOP

Potential problems are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Excess bleeding
  • Infection
  • Blood clots
  • Knee instability
  • Continued pain, numbness, or stiffness in the knee
  • More surgery in the future if the treatment fails

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic diseases, such as diabetes or obesity

What to Expect    TOP

Prior to Procedure

The following will be done before the procedure:

  • Physical exam
  • Blood tests
  • Imaging tests, such as an x-ray or MRI scan

You will need to:

  • Arrange for a ride home after the procedure
  • Talk to your doctor about any medications, herbs, or supplements you are taking
  • Ask your doctor if you will any assisted devices (cane or crutches) at home during your recovery

You may need to stop taking some medications up to one week before the surgery. Talk to your doctor about any medications that may need to be stopped.

Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

The type of anesthesia will depend on your medical history and extent of your injury. Options may include:

  • Spinal anesthesia—You will be awake, but have no feeling in your leg. A sedative may be used to ease anxiety and help you relax.
  • General anesthesia—You will be asleep through the procedure.

Description of Procedure     TOP

The procedure is most often done with a minimally invasive procedure. Small incisions are made around the knee. Special tools will create paths in the incisions for surgical tools to pass.

Repair

If enough of the ligament is intact, the surgeon may simply secure the damaged PCL back onto the bone. Tears in the ligament itself will be repaired with sutures. The ligament may also be secured to the bone with sutures.

Reconstruction

Reconstruction involves the use of tendon tissue from another part of the body or from a donor cadaver. The remains of the damaged ligament are cleaned away from the knee joint. Small incisions are made in the surface of the thighbone and shinbone inside the knee. The donated tendon is threaded through these incisions and secured with screws or staples. Over time the bone will grow over the tendon to form a tight connection.

Once the graft is securely in place, the doctor will test the knee’s range of motion.

When either procedure is done, the skin will be closed with stitches. Bandages will be placed on the knee.

Immediately After Procedure    TOP

Breathing, blood pressure, and vital signs will be monitored in a recovery room after the procedure.

How Long Will It Take?     TOP

Up to 2 hours depending on what needs to be done.

How Much Will It Hurt?     TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Post-procedure Care     TOP

At the Care Center

While at the care center, the staff will:

  • Offer pain medications to keep you comfortable
  • Place ice packs on your knee to reduce swelling and pain
  • Teach you how to use crutches
  • Teach you light exercises to do at home

During your stay, the care staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home

Recovery will focus on pain relief and rehabilitation. A knee immobilizer and crutches will be used during early recovery to keep you mobile but decrease stress on the knee. You can gradually return to regular activity as recommended by your doctor.

Home exercise or physical therapy will be needed to maintain strength and mobility in the leg.

Complete recovery can take 6-9 months.

Follow your doctor's instructions.

Call Your Doctor     TOP

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any yellowish discharge from the incision site
  • Swelling, pain, or heat in the calves, which may indicate a blood clot
  • Pain that can’t be controlled with medications you’ve been given
  • Numbness in the knee area
  • Persistent nausea or vomiting
  • New or worsening symptoms

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org
Sports Med—American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Knee ligament repair. John Hopkins Medicine website. Available at:
...(Click grey area to select URL)
Accessed February 11, 2016.
Rosenthal MD, Rainey CE, et al. Evaluation and management of posterior cruciate ligament injuries. Phys Ther Sport. 2012;13(4):196-208.
Last reviewed February 2016 by Warren A. Bodine, DO, CAQSM

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