The knee is one of the largest and most complex joints in the body. The knee is made up of bones, cartilage, ligaments, and tendons. The knee joins the thigh bone (femur), the shin bone (tibia), the smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) altogether to make up the knee joint. The knee is a synovial joint, meaning it contains a fluid-filled capsule.
Tendons connect the knee bones to the leg muscles that move the knee joint, and ligaments join the knee bones and provide stability to the knee.
WHAT IS PCL RECONSTRUCTION?
The Posterior cruciate ligament (PCL) is one of four major ligaments of the knee that is situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia) and prevents the shinbone from moving too far backwards. PCL reconstruction is done to repair a torn PCL, by using a tissue graft taken from another part of your body, or from a donor.
PCL injuries are not as common as other knee ligament injuries, and are often subtle and difficult to detect. Additionally, PCL injuries usually occur together with other injuries such as cartilage injuries, bone bruises, and ligament injuries.
There are 3 grades of a PCL injury:
- Grade 1
The ligament has been mildly damaged and slightly stretched but is still able to help keep the knee joint stable.
- Grade 2
There is partial tear of the ligament, where the ligament is stretched to the point where it becomes loose.
- Grade 3
There is a complete tear of the ligament, where the ligament has been split into two pieces, resulting in an unstable knee joint.
WHAT ARE THE SYMPTOMS OF A PCL INJURY?
Common symptoms after suffering from a PCL injury include:
- Knee pain and swelling
- Knee joint instability
- Knee stiffness that results in difficulty walking
WHAT ARE THE CAUSES AND RISK FACTORS OF A PCL INJURY?
A PCL injury requires a strong force. Some causes are:
- A direct impact to the front of the knee, such as during a car accident where your bent knee strikes the dashboard forcefully
- Falling onto the ground on your bent knee during sports
- Twisting and pulling the knee ligament
WHAT IS THE DIAGNOSIS OF A PCL INJURY?
A history of the injury and a physical examination of the knee will be conducted by the Doctor.
Imaging tests such as an x-ray may be ordered to rule out other injuries such as an avulsion fracture, and an MRI scan may be taken to view the tissue better.
WHAT HAPPENS DURING A PCL RECONSTRUCTION SURGERY?
PCL reconstruction surgery involves replacing the torn PCL ligament with a tissue graft, which is taken from another part of your body or from a donor. This procedure involves an arthroscope using a few small incisions.
After removing the torn PCL ligament, two holes called “tunnels” will be drilled into your thighbone (femur) and shinbone (tibia). The graft is then inserted and secured to your bones with screws or other devices. The graft will serve as a scaffolding on which new ligament can grow.
WHAT ARE THE RISKS AND COMPLICATIONS OF A PCL RECONSTRUCTION SURGERY?
As with any type of surgery, there are risks accompanied. These include:
- Knee stiffness and instability
- Blood clotting
- Nerve and blood vessel damage
- Failure / loosening of the graft
WHAT HAPPENS AFTER A PCL RECONSTRUCTION SURGERY?
It is advised to keep the knee straight, with the help of a knee brace for 2 to 4 weeks. There should not be any weight placed on the knee, and supports should be placed under the tibia while at rest at home for the first 2 months after the surgery.
Physiotherapy and weight bearing will start after 8 weeks, to help you regain muscle strength and knee mobility.