Posterior Cruciate Ligament Tear

with Phase I Rehab

ExitCare ImageThe posterior cruciate ligament (PCL) is the strongest of the four major ligaments that are responsible for stabilizing the knee. The PCL, specifically, is responsible for preventing the shinbone (tibia) from displacing to the back (posteriorly). The PCL is susceptible to being torn (sprained). Sprains are classified into three categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be diminished. Grade 3 sprains are characterized by a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • "Pop" or tear felt in the knee at the time of injury.

  • Knee swelling (effusion) within 6 to 8 hours.

  • Inability to straighten knee.

  • Recurrent buckling, giving way of the knee.

  • Locking of the knee, if the injury also involve damage to the meniscus.

  • Knee pain that is usually, achy pain, but may be sharp.

  • Difficulty running backward (back-pedaling).

CAUSES

A PCL tear occurs when a force is placed on the tendon that is greater than it can withstand. Common mechanisms of injury include:

  • Direct trauma, such as being tackled at the knee.

  • Indirect trauma, such as excessive straightening of the knee (hyperextension).

RISK INCREASES WITH:

  • Contact sports (football, rugby, or soccer).

  • Poor strength and flexibility.

PREVENTION

There are no known preventative measures for this condition. But the following may help:

  • Warm up and stretch properly before activity.

  • Learn and use proper technique.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

PCL ligament tears are usually treated without surgery. Rehabilitation usually requires 3 to 8 months before activity may be resumed. It is unknown whether or not surgery will improve this condition.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a chronic problem.

  • Inability to compete in athletics.

  • Prolonged healing time, if improperly treated or re-injured.

  • Concurrent injury to other structures such as ligaments, menisci, or articular cartilage.

  • Arthritis of the knee.

  • Knee stiffness (loss of knee motion).

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. It is recommended that you walk with crutches until it is possible to walk without a limp. It is important to perform strengthening and stretching exercises to regain function of the knee. These exercises may be performed at home. However, it is usually recommended that you visit a therapist. Your caregiver may also recommend that you wear a brace to help stabilize the knee.

Currently there is no way to surgically reconstruct the PCL, thus conservative rehabilitation is the best method of treatment. If the PCL tear is associated with a tear of another ligament of the knee that can be surgically repair (the anterior cruciate ligament), then reconstruction for a PCL tear may be attempted. Followed by a rehabilitation program.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Posterior Cruciate Ligament Tear - Phase I

These are some of the initial exercises that your physician, physical therapist or athletic trainer may have you perform to begin your rehabilitation. When you demonstrate gains in your flexibility and strength, your clinician may progress you to Phase II exercises. As you perform these exercises, remember:

  • These initial exercises are intended to be gentle. They will help you restore motion without increasing any swelling.

  • Completing these exercises allows less painful movement and prepares you for the more aggressive strengthening exercises in Phase II.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your opposite knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Knee Flexion, Supine

  • Lie on the floor with your right / left heel/foot lightly touching the wall (place both feet on the wall if you do not use a door frame).

  • Without using any effort, allow gravity to slide your foot down the wall slowly until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your health leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending): Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your right / left thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your clinician may advise you to add an ankle weight if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you place a __________ weight on your ankle to deepen the stretch.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Posterior Cruciate Ligament Tear - Phase I

These are some of the initial exercises that your physician, physical therapist or athletic trainer may have you perform to begin your rehabilitation. When you demonstrate gains in your flexibility and strength, your clinician may progress you to Phase II exercises. As you perform these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your caregiver. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under his or her guidance.

ExitCare Image STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor/mat/bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee so that the knee slightly bends.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 lb/0.5 kg increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working to insure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even quiver.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.