With good physical examination, the PCL pr Posterior Cruciate Ligament injury can be identified, however when the knee is acutely swollen and painful, it may be difficult to examine.
X-ray. X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray.
MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the PCL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention.
First Aid for PCL injuries involves the typical R.I.C.E therapy for the first week.
Rest. It is important to minimize walking around.
Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling
Compression. Crepe bandage is sufficient to help with compression.
Elevation. Keeping it elevated on a pillow when resting helps.
PCL Prehab exercises can be started once the pain and swelling improve. These help in regaining the knee movements and keep the muscles in a good condition.
Surgery is recommended in people leading an active lifestyle and are physiologically fit. Without surgery, one can manage but will have to limit the activities and be cautious on uneven surfaces to not twist again.
PCL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. The graft material is either the hamstring tendons or peroneal muscle tendon from the side of the lower leg harvested through small cuts. The whole surgery is performed with the help of the camera (arthroscopy) and small cust (keyholes). Usually on one side the graft is fixed with a small titanium button and on the other side with a bio-composite screw. In some instances to increase the thickness of the graft, an all inside technique where both sides small titanium buttons are used.
Post-surgery, you are allowed to walk on the same day evening. If meniscus is intact and only PCL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg with the support of a walker. Within a week most people manage to walk without support. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole process of rehabilitation will take about 6 to 8 months before returning back to playing sports on the ground or court.