Τhe rupture of the Posterior Cruciate Ligament

The ligament located at the back of the knee is known as the Posterior Cruciate Ligament or PCL or ρηξη χιαστου
. It is one of several ligaments that connect the femur (the thigh bone) to the tibia (the leg bone). The PCL is the strongest ligament in the knee and, therefore, breaks less frequently accounting for approximately 3-37% of knee injuries. When the PCL breaks down, patients report having problems with deceleration, problems going down stairs, walking on inclines, and with twisting in general. Posterior cruciate ligament injuries are almost always caused by an impact, for example when the player falls on a flexed knee or violently collides with an opponent. In general, isolated posterior cruciate ligament injuries heal on their own over time, but it is important to make an early diagnosis of a rupture of this ligament to attempt to heal in a stable position, rather than a stretched, non-functional position.

While the MRI result is useful for an acute injury assessment, this investigation is not very useful in the case of a chronic injury because it can show intact but non-functional PCL. The diagnosis of PCL injury is made during the visit to the doctor who observes the posterior translation of the knee. It will be evaluated how much the tibia slides posteriorly on the femur with respect to the healthy side, an active test will be performed by contraction of the quadriceps muscle and the posterior drawer test will be performed in neutral rotation.

DEGREE OF INJURY

Grade 1: small partial leisone.
Grade 2: complete injury.
Grade 3: Complete injury and the ligament becomes nonfunctional, usually this occurs with associated injuries of the other ligaments of the knee Isolated Grade 1 and 2 PCL injuries should be treated with a non-surgical program that consists of wearing an PCL brace to help keep the knee in a more functional position for PCL and referral to a specialized medical rehabilitation center.

Surgery

Surgery in this type of injury is very rare and often a complete functional and sporting recovery is returned through a personalized rehabilitation program in the pool, in the gym and in the field. In complete PCL ruptures in patients who have more than 8mm of posterior tibial translation over the femur, surgery consisting of PCL reconstruction will be required and this will be done in young patients to improve their knee function and to decrease the likelihood of develop osteoarthritis of the knee in the future and in patients between the ages of 35 and 45 only if they are still athletes of a level or if they have symptomatic instability that prevents them from carrying out common activities in peace such as climbing and descending stairs. In case of intervention, it will be crucial for the return to sport to complete a specific rehabilitation program. The return to competitive sports is expected 6-10 months after surgery and this varies a lot if only the PCL has been reconstructed or if, as much more often happens, multiple ligament reconstructions have to be made.