| Category | ACL Arthroscopy |
About PCL
PCL is the strongest and bulkiest ligament of the knee. It prevents backward/posterior displacement of the tibia (leg bone) over the femur (thigh bone). A PCL injury is not as common as an ACL injury.
PCL Injury
As it is a bulky ligament, PCL injury occurs in severe knee injuries like road traffic accidents( dashboard injury) and knee dislocations. Athletes can also injure their PCL during high-energy injuries while playing.
Symptoms
Immediately after a PCL injury, the patient complains of a painful, swollen knee with the inability to bend the knee. After a few days, the pain and swelling subside but the patient complains of instability while walking, jumping, climbing upstairs, playing sports. This leads to a loss of confidence on the knee and the inability of an athlete to perform/compete at their pre-injury level.
Diagnosis
PCL tear can be diagnosed in a sports clinic by a sports injury specialist by performing a variety of clinical tests. Clinical diagnosis is confirmed radiologically by an MRI scan of the knee. A grade 3 tear reported in an MRI is a complete tear, while a grade 2 or grade 1 tear is a partial tear.
Treatment
A complete PCL tear (grade 3) is treated by surgical management in symptomatic, young, active patients. Athletes and people ages below 50 yr do very well with surgical treatment. Partial tears/ grade (1/2) injuries can be managed conservatively.
Why Surgery?
The human body is unable to repair a torn PCL by itself. In a knee with torn PCL, repeated episodes of instability cause further damage to the meniscus, articular cartilage as well as other ligaments of the knee. These changes predispose to early-onset osteoarthritis.
Timing of Surgery
The asymptomatic patient should get operated on for his/her torn PCL as soon as the knee pain and swelling subsides and the knee range of motion improves to 110-120 degrees. This usually takes a few days to weeks post-injury. Delay in surgery might lead to unwanted damage to articular cartilage, meniscus, and other ligaments.
Surgical Procedure
Arthroscopic reconstruction of PCL is the gold standard procedure for complete PCL tears. Tendons from patient's own body (graft) are used in this procedure. Most commonly hamstrings or BTB ( bone-patellar tendon-bone) grafts are used. After harvesting these grafts, they are prepared and fixed to the femur and tibia using special screws/buttons. This requires the drilling of small tunnels in both bones.
Post Operative Rehabilitation
The patient walks the day after surgery. With the help of a specialized formulated post-op rehabilitation regimen, muscle strengthening is promoted. Active Knee bending and full weight-bearing are restricted for initial 4-5 weeks. Return to competitive sports takes 7-8 months.
