The posterior cruciate ligament (PCL) is one of two cruciate ligaments found at the back of the knee. PCL injury is rare as they are one of the stronger ligaments in the knee. Rarely occurring in isolation, PCL injuries tend to be accompanied by injuries of other ligaments or the meniscus.

There are 2 ways in which PCL reconstruction can occur, these are:

• Arthroscopic surgery: arthroscopy surgery, also known as an arthroscopic transtibial reconstruction, allows diagnosis and treatment to be executed together.
• Open tibial inlay technique: an open tibial inlay technique, is not typically preferred as it raises concerns of post-surgical complications, such as risk to the neurovascular structures, and increased operating room time.

Your orthopaedist will recommend an arthroscopic PCL reconstruction if:

• An acute PCL reconstruction surgery is necessary. Acute in this context means the conservative approach to recovery is not considered. Reconstruction surgery is non-negotiable when patients have incurred a 3rd-grade injury which involves a complete tear or rupture of the ligament or if there is evidence of multi-ligamentous injury.

• The conservative approach provides no relief of symptoms. If 2nd-degree injuries show no improvement and pain progresses.
• Patients specify a desire to return to sports or athletic endeavours; patients that are athletes tend to seek treatment with the quickest recovery rate.

Following the assessment, a graft selection – tissues used to reconstruct PCL structures, is made. Options for types of graft include autografts (harvested from one's own body), and allografts (obtained from a donor).

Two or three small incisions are made at the knee and an arthroscope is inserted, allowing your orthopaedic surgeon to visually assess the condition of your knee through the camera. This phase of the procedure is also known as arthroscopic diagnosis.

Next, the preparation of grafts is conducted. The procedure will vary depending on the type of graft which was obtained. Following the preparation, bone tunnel placements will be made to create space for  graft fixtures. On top of addressing PCL reconstruction, other injuries that may have occurred such as ACL or meniscus injuries will also be addressed during the surgery.

The surgical site is then irrigated to prevent infections before it is closed either by suture or staples.  

• Minimally invasive
• Quicker discharge
• Minimal scarring
• Minimises likelihood of knee arthritis and instability

PCL reconstruction can be used to treat the following conditions:

• PCL tears: such as isolated, proximal, and distal PCL tears– uncommon injuries that involve damage to the PCL.
• PCL avulsion fracture: commonly seen in victims of vehicular accidents and occurs when the posterior or back tibial section separates from the PCL.
• PCL deficiency: occurs due to PCL injury, leading to the PCL being unable to stabilise the knee properly.
• Multi-ligament knee injuries: also known as MLKI, it involves a combination of PCL injuries, MCL injuries, ACL injuries, and LCL injuries.

PCL surgeries are complex with various reconstruction techniques required, however, the success rate for PCL surgery is around 85%. This indicates that a high recovery rate is evident and regaining pre-injury strength and stability is likely. Athletes with goals to return to sports activities too, have a high probability with a current reported success rate of 80-91%.

The recovery process varies for everyone depending on the type of PCL injury incurred. Generally, it takes a longer time to heal from PCL injury, this factor is attributed to the fact that PCL is a large ligament and in comparison, a much stronger ligament than others. For a third-grade injury to occur in the first place, it would have taken significant damage, justifying the length of recovery.

It can take up to 12 months for complete recovery and return to daily activities.

Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.

PCL arthroscopic surgery is a one-off treatment. The only variation is the time it may take in the operating theatre especially when multiple injuries are sustained.

Treatment for PCL injury does not stop at surgery. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers. The frequency of physiotherapy sessions will vary according to your personal goals such as the need to return to athletic endeavours.