Even though the anterior cruciate ligament (ACL) gets most of the attention in sports, injuries to the posterior cruciate ligament (PCL) can also affect athletes and their seasons. This week we saw both Running Back Felix Jones of the Dallas Cowboys and Wide Receiver Anthony Gonzalez of the Indianopolis Colts sidelined with PCL ligament injuries.
Although less commonly injured than the ACL, the PCL can be strained or torn from direct blows to the shinbone (“tibia”) or from a fall on a flexed knee on the field. These injuries are therefore more common in contact sports like football, but can also result from non-athletic injuries like a bumper or dashboard injury to the shinbone during a car accident. The PCL normally resists the shinbone from behind pushed back relative the thigh bone (“femur”), and together with the ACL, it plays an important role in stabilizing the knee for athletes who are constantly running, twisting, and cutting on the field.
PCL tears can occur in isolation or, more commonly, together with injury to other stabilizing structures of the knee. The athlete will usually complain of knee swelling and pain after a forceful blow or landing. Sometimes, however, PCL tear can occur after a noncontact, hyperextension injury on the field with a sense of the knee “bending in the wrong direction.” On physical exam, the knee will be swollen and can be tender to palpation in the back. The shinbone can be pushed back more than the normal with the knee flexed, and often appears to “sag” with a tear of the PCL. If other ligaments are injured, the knee may also be more unstable with side-to-side or rotational movement as well. Imaging studies an help to confirm the diagnosis. Plain x-rays are usually normal, but occasionally may show an avulsed bone fragment where the PCL attaches to the shinbone. An MRI is usually the gold standard and will not only show injury the ligament, but will also allow an evaluation of all of the other soft tissue structures stabilizing the knee joint.
The management of PCL injuries can be complex, and a suspicion of injury should prompt a visit to your sports medicine orthopaedic physician. Treatment must be individualized, and is dependent upon several factors including the severity of injury, patient expectations, and activity level. Some isolated injuries of the PCL can be treated nonoperatively by strengthening the muscles around the knee than can compensate for function of the ligament, most importantly the quadriceps muscles. Even NFL players have recovered from these injuries through rehabilitation and returned to a professional level of play. High grade tears or combined injuries, however, may sometimes require surgical reconstruction to stabilize the knee. Fortunately, surgical techniques have considerably evolved to allow these procedures to be performed in a minimally invasive fashion through “arthroscopic”, camera-assisted surgery.
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