Posterior Cruciate Ligament Tear

with Phase II 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

PHASE II EXERCISES

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

After your physician, physical therapist or athletic trainer feels your knee has made progress significant enough to begin more advanced exercises, he or she may recommend some of the following exercises. Do not begin these until you have your clinician's permission. He or she may also advise you to continue with the exercises which you completed in Phase I of your rehabilitation. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • 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 STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool

  • Keeping a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

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

ExitCare Image STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall and the opposite leg flat on the ground through the door. Initially, position your bottom farther away from the wall than the illustration shows.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door, and hold __________ seconds.

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

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach, your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and/or knee.

  • Hold this position for __________ seconds.

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

STRENGTHENING EXERCISES - Posterior Cruciate Ligament Tear Phase II

These are some of the exercises you may progress to in your rehabilitation program. Do not begin these until you have your clinician's permission. Although your condition has improved, the Phase I exercises will continue to be helpful and you may continue to complete them. As you complete strengthening exercises, remember:

  • 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 - Hamstrings, Curl

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed/floor.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

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, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door and walk your feet out 18-24 inches. Place your feet hip-width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds in between each repetition.

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

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.

ExitCare Image STRENGTH - Quadriceps, Squats

  • Stand in a door frame so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs upright so that they are parallel with the door frame. Squat only within the range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return upright, pushing with your legs, not pulling with your hands.

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

ExitCare Image STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Holding a wall or counter for balance only, not support.

  • Slowly step-up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

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

ExitCare Image STRENGTH - Quadriceps, Step-Downs

  • Stand on the edge of a step stool or stair. Be prepared to use a countertop or wall for balance, if needed.

  • Keeping your right / left knee directly over the middle of your foot, slowly touch your opposite heel to the floor or lower step. Do not go all the way to the floor if your knee pain increases, just go as far as you can without increased discomfort. Use your right / left leg muscles, not gravity to lower your body weight.

  • Slowly push your body weight back up to the starting position,

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