Clinical Education

PCL Injuries

Posterior cruciate ligament tears:

Tears of the posterior cruciate ligament (PCL) are less common than ACL injuries due to the greater strength of the PCL. Furthermore, it is commonly under diagnosed because many people can function normally without a PCL. However, this can lead to significant osteoarthritis later in life.

PCL injuries are often due to a blow to the shin while the knee it’s bent. Common causes include:

  • Striking the knee against the dashboard during an motor vehicle accident
  • Falling on the knee whilst bent

In sports a PCL injury can occur when the athlete falls to the ground on a bent knee


Bone bruise pattern in posterior cruciate ligament (PCL) injury. Arrow indicates bone bruise in the anterior portion of lateral tibial plateu that occurred in a patient with grade III PCL injury shows vector of force and injury mechanism

Subjective History:

Unlike ACL injuries, patients report very little pain or swelling. They describe vague symptoms unsteadiness or insecurity of the knees. Patients who have long standing PCL injuries that have not been diagnosed can report pain around the knee cap

Objective Examination:

On examination, minimal swelling as the PCL is an extrasynovial structure
Positive sag of the tibia, Posterior Draw and Reverse Lachman’s test is positive in PCL disruption
PCL rupture can be generally managed conservatively with a comprehensive rehabilitation programme, focusing on quad strength


Image from OpenI – Licensed by CC


Initial management should involve protection, rest, ice, compression and elevation (PRICE).
Painful activities should be avoided
Progressive loading of the knee through active rehabilitation
The treatment regimen can be summarised as follows:

0-48 hrs:

Active pain-free exercises (gentle range of movement)
After the first 48 hrs:

Gradually increase strength:
Active knee flexion and extension
Knee brace, active single leg raise and inner range quads.
Progress loading – Chair/wall squats and stair step-ups
Knee stability exercises (e.g. pulleys with other leg, one-leg squats)
Low impact cardio, cycling and swimming, lower limb strengthening exercises if access to a gym
Functional Strengthening:

Pool running
Sport Specific skills:

Jumping and landing
Running-straight line
Running-figure of eight
Rapid changes of direction (cutting drills)
Kicking-gradual increase

Image from OpenI – Licensed by CC