PCL and Posterolateral Knee Ligament Injuries

There are 4 main ligaments in the knee that help keep the joint stable when we walk, run, go up and down stairs, kneel – during any weight bearing activity. In addition, the muscles and other soft tissues in the knee joint help provide stability. While the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are commonly torn, the posterior cruciate ligament (PCL) and lateral collateral ligament/posterolateral structures (LCL/PLS) may also be injured and cause considerable problems if left untreated. There are many different combinations of ligament tears that are seen in orthopaedic and sports medicine centers. High-velocity injuries frequently cause knee dislocations, with multiple ligaments and structures torn that require immediate medical attention. The LCL/PLS are often torn along with the PCL and/or the ACL.

Injuries to the PCL and/or LCL/PLS are difficult to treat and in fact often go undiagnosed. Once detected, the decision of whether to handle these injuries conservatively (with physical therapy) or with surgery requires an orthopaedic surgeon who has thorough knowledge of knee anatomy, the ability to perform multiple diagnostic tests, experience performing various surgical reconstruction procedures, and experience directing physical therapy after surgery. Patients present with very different situations, ranging in scope from an acute isolated PCL tear to a dislocated knee to a knee with chronic combined PCL-LCL/PLS tears and early arthritis.

Problems that may happen from chronic injuries to the PCL and/or LCL/PLS include pain and instability with squatting, kneeling, stair climbing and descending, and rising from a chair. The knee may extend too far backwards (hyperextend) or bow outward, making it painful and unstable and change the way a patient normally walks. This gait abnormality may then cause problems to the hips and back. Knee arthritis is a frequent result of these injuries if they are severe and not effectively treated. Symptoms of knee arthritis include pain and swelling with sports and then, as the damage progresses, with daily activities

After treating patients for nearly 4 decades with all types of knee ligament tears, we decided to write this eBook to try to help individuals understand injuries to the PCL and LCL/PLS, the treatment options that are currently available, and what to expect as a result of these options. This eBook provides information on basic knee anatomy; the function of the PCL and LCL/PLS and why they are so important; how to find an orthopaedic surgeon; how knee ligament tears and other problems in the knee are diagnosed; the treatment options for partial and complete tears to the PCL and LCL/PLS; and advice on what to do if damage has occurred to other parts of the knee. If you decide to have surgery, we also provide information on different reconstructive options, what to expect from the operations, how to prepare for the operations, and how the operations are performed. The postoperative physical therapy programs developed over many years at our Center are also presented in detail.

About Sue Barber-Westin

Sue Barber-Westin has been a member of the Cincinnati Sportsmedicine Research and Education Foundation staff since its establishment in 1985 and serves as Director of Clinical and Applied Studies. She has co-authored over 120 articles in peer-reviewed medical journals and textbooks, focusingon the clinical outcome of various knee operative procedures and on neuromuscular indices in young athletes. Sue is the associate editor, along with editor Dr. Frank Noyes of the orthopaedic textbook, “Noyes Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes” published in 2009. In 2004, Sue and Dr. Noyes were members of the research team that won the Clinical Research Award from the Orthopaedic Research and Education Foundation, the highest clinical research honor bestowed annually in orthopaedics.