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Department of Arthroscopy
PCL Treatment

Choose the finest PCL treatment and surgical care at Sri Balaji Hospital in Chennai. Reclaim your mobility and bid farewell to persistent pain.
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Posterior Cruciate Ligament

Posterior Cruciate Ligament is naturally found just posterior (behind) the anterior cruciate ligament. This ligament is one of the main stabilisers of the knee and acts similarly to the Anterior Circulate Ligament. However, unlike the ACL, the PCL provides stability to the posterior (back) of the knee and prevents the joint from sliding backwards / causing backward instability.

MRI of normal knee showing PCL.

Anatomy Of The  Posterior Cruciate Ligament

The Posterior Cruciate Ligament comprises a thick bundle of ligamentous fibres, which provides a strong connective tissue between the femur (thigh bone) and the tibia (leg bone).

Mode of Injury

Posterior Cruciate Ligaments ((PCL) injuries are far less common than their anterior counterpart, the ACL. This is partly because the mode of injury is less likely to occur than that of an ACL. Tearing a posterior cruciate ligament takes a lot of force and high impact. It can be caused by:

  • High impact injury to the FRONT of the knee, which in turn results in the joint bending forward and stretching the ligament at the back (PCL) to the point that it snaps.
  • Road traffic accidents resulting in high-impact injury to the front of the knee.
  • Knee dislocations after road traffic accidents or high-intensity sports injuries.
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Symptoms of  PCL Injury

Persistent pain, even if mild or dull, lasting 2 to 3 weeks post-injury.
History of an injury preceding the onset of pain.
Knee Locking: The inability to extend the knee and stand after prolonged sitting for a few minutes or hours. Notably, knee locking may indicate a possible meniscal tear, necessitating confirmation by one of our specialists.
Pain predominantly experienced at the back of the knee despite the impact being at the front.
Knee instability, characterised by a sensation of slippage or 'giving away' while walking.
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What Should You Do?

Ice application
Crepe bandage application
Visit one of our specialists for consultation

Our Specialist’s Protocol for Management of PCL Injuries

Elicit a thorough history. We at Sri Balaji Hospital use a grading system to assess and decide the best path to take for the patient’s benefit.
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Physical examination to confirm the presence of a ligament instability in the knee.
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An MRI scan may be suggested to confirm the physical finding and also to confirm/rule out associated knee injuries.
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Do All Ligament Injuries Require Surgery?

NO. Not all ligament surgeries require surgery. 
The grading system we follow to assess and decide the need for surgery is as follows:
  • Grade I. A partial tear is present in the ligament.
  • Grade II. There’s a partial tear, and the ligament feels loose.
  • Grade III. The ligament is completely torn, and the knee is unstable.
  • Grade IV. The PCL is injured, and another knee ligament is damaged.

Following the above-mentioned protocol, grade II tears are considered relative indications. The decision on whether surgery is the best option takes into account the patient's pre-injury lifestyle, their specific demands, and the diagnosis. Conversely, grades III & IV tears typically benefit the most from arthroscopic surgical intervention in a majority of cases.

We engage in thorough discussions with you to assess the surgery's potential benefits in alignment with your pre-injury lifestyle. Our ONLY objective is to restore your pre-injury lifestyle, free from pain and injury. If surgery is identified as the optimal path to achieve this goal, we will openly discuss it with you and proceed based on your priorities and requirements. On the other hand, if there is a significant likelihood of attaining these objectives through non-operative means, our surgeons will prioritise this as the initial choice.

The decision for arthroscopic surgery is contingent upon various factors, the most important of them being:
Older age groups, individuals with arthritis, or those with limited physical activity pre-injury may necessitate exploring non-surgical options. Conversely, young (20 to 45 years age group) individuals who lead an active lifestyle with regular and intense physical activity and wish to pursue the same even after the injury will benefit from arthroscopic reconstruction of the PCL.
Partial or mild tears do not require surgery. Similarly, even full-thickness tears can be treated conservatively until/unless the patient is symptomatic or experiences instability of the affected knee.
Physical demands placed on the knee by the individual
Active individuals, individuals who run/ workout regularly, and athletes will benefit from arthroscopic PCL reconstruction surgeries.

Benefits of Surgical Intervention

Quicker healing time.
Faster return to activity/ sports.
Return to pre-injury levels of physical activity.
Less risk of recurrence of symptoms.

Complications of Non-Surgical Intervention

Risk of continued/ worsening of pain.
Risk of continued/ worsening of instability.
Reduction in physical activity.
Risk of developing arthritis of the affected knee in the long term future.

Surgical Technique

At Sri Balaji Hospital, we employ the state-of-the-art Smith & Nephew arthroscopic system renowned for its 4K quality, providing a comprehensive visualisation of the affected joint. This advanced system allows for a meticulous screening of associated injuries, which are occasionally overlooked in standard MRI studies.

The actual procedure involves making 2 key hole-sized incisions (portals) on the front of the knee, one to accommodate the camera and the other portal to make way for the entry of the arthroscopic surgery instrumentation. A third mini-incision may be made for the passage of the graft or the screw which fixes the muscle or tendon graft.

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Reconstruction of the PCL

It involves acquiring a substitute which will mimic the natural ligament closest in terms of strength as well as flexibility of the native ACL. This substitute is termed as a “graft”. This graft is of 2 types:
The Muscle Graft
The Bone-Tendon-Bone Graft

Typically acquired from the lower thigh, with the semitendinosus muscle being the preferred choice. This muscle is looped 2 or more times to ensure ample strength to support the individual's body weight and cater to the demands of their physical activities. It is especially suitable for individuals seeking greater flexibility and are less engaged in contact sports, thus minimising the risk of sports-related injuries.

This method utilises a portion of the patellar tendon accompanied by a small bone fragment to enhance strength and fortify the knee against potential impacts and high-intensity contact, typical in vigorous sports. While this graft offers notable strength, it can lead to reduced flexibility if post-operative rehabilitation is insufficient.

Image of a patient sitting on bed in hospital ware knee brace support after do posterior cruciate ligament surgery.
What Material is Used to Fix the Graft?
Here at Sri Balaji Hospital, we often prefer a “bio-absorbable” type of material as an implant to fix the graft, as it is known to get absorbed biologically within 12 to 18 months. It causes less risk of implant-related complications and does not cause any hindrance to repeat MRI scans in the future. Alternatively, a titanium implant can be used. This material is also MRI-compatible but will physically remain in the body until removed (if necessary).
Post-Operative Period

You can:

  • Walk on the same day of surgery.
  • Start knee-bending exercises the next day.
  • Discharge within 24- 48 hours.
  • Return to office/ school/ college within 2 weeks.
  • Return to vehicle driving within 6 weeks.
  • Return to running/intense physical activity within 6 months.
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Sri Balaji Hospital is a centre for Orthopaedics and Traumatology and is unwavering in its commitment to providing high-quality healthcare at affordable rates. Our dedication stems from the belief that you, the community, are at the core of every endeavour, deserving nothing less than the utmost care.
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