PCL Tear Treatment
Patients who have a complete PCL tear with less than 8 mm of posterior translation can be considered for a non-operative rehabilitation program in special circumstances. However, in most patients who have 8 mm or more of increased posterior knee translation, there is a much higher likelihood than not that these patients will need a posterior cruciate ligament reconstruction surgery to improve their knee function and decrease their chances of developing knee arthritis. Thus, in a higher-level athlete, it is usually recommended to proceed with the PCL knee reconstruction because results of acute reconstructions are much better than chronic reconstructions.
When Dr. LaPrade makes the determination that a patient does need a PCL reconstruction, he thoroughly assesses the patient to see if there is any concurrent injury. Approximately 90% of patients who have persistent PCL tear symptoms limiting their function also have a posterolateral corner, posteromedial injury or other associated injury. Thus, the incidence of isolated PCL reconstructions in our own series is approximately 10% of the total posterior cruciate ligament reconstructions performed.
Dr. LaPrade’s surgical rehabilitation technique for a PCL reconstruction is an endoscopic-based double bundle reconstruction with allografts using a technique that he has developed. It utilizes minimal incisions and does not violate the quadriceps mechanism like conventional posterior cruciate ligament reconstruction surgery techniques. The double bundle PCL reconstruction has been extremely effective in restoring knee stability back to the patient both objectively with PCL stress x-rays and subjectively based on patients independently evaluating their outcome scores.
PCL Surgery Recovery
PCL surgery recovery involves patients to initiate prone knee flexion at 0-90° on day one. They use a PCL jack brace for six months postoperatively to reduce the posterior gravitational stress to the knee. Patients initiate a partial protective weight-bearing program at six weeks postoperatively and wean off of crutches at that point when they can walk without a limp. Patients may initiate the use of a stationary bike and leg presses to a maximum of 70° of knee flexion at 6 weeks postoperatively.
We have found that our PCL rehab protocol, which may be considered aggressive by other treatment centers because we initiate motion with PCL reconstructions on postoperative day one , has not resulted in any of our grafts stretching out over time and has demonstrated a much quicker return of knee motion, decreased risk of knee stiffness and high level function.