This page gives information on the surgical management of Posterior cruciate ligament injuries. To know more about PCL tears in general, Click Here 

When do I need this surgery?

1. Isolated Grade 3 PCL tears: Surgery is strongly indicated, especially in active patients.
2. Combined ligament injuries: When a PCL tear occurs with other injuries like ACL tear or posterolateral corner injury.
3. Failed non-operative management with persistent pain or instability symptoms
4. PCL avulsion fractures: If the ligament is torn away with a piece of bone

What are the benefits of the surgery?

1. Increased knee stability: Reconstruction stabilizes the knee allowing patients to resume physical activities without the fear of instability or further injury.
2. Improved knee function and range of motion
3. Prevention of further knee damage: Reconstruction reduces the risk of additional injuries to the knee, such as damage to cartilage, meniscus, or other ligaments, and helps prevent the development or progression of osteoarthritis.
4. Return to an active lifestyle

What will happen if I don’t have surgery?

1. Increased risk of arthritis: Untreated PCL tears are associated with a higher risk of developing knee osteoarthritis due to abnormal joint mechanics and increased cartilage wear.
2. Chronic instability, which can make activities like walking, running, or navigating stairs difficult and sometimes painful.
3. Increased risk of additional injuries to the cartilage, meniscus, or other ligaments.
4. Reduced function and chronic pain

It is worth noting that not every patient with a PCL tear requires surgery: mild (low-grade) injuries may respond well to structured rehabilitation and non-operative measures. However, the risk of long-term issues is higher in those with significant injuries or persistent instability who forego surgical reconstruction.

What does the surgery involve?

PCL reconstruction surgery is done as a key-hole (arthroscopic) procedure. The surgery is done under Spinal or General anaesthesia. Using arthroscopic techniques the damaged posterior cruciate ligament is removed and replaced with a tendon graft. The commonly used grafts are hamstring, quadriceps or patellar tendon. Tunnels are created in the tibia (shin bone) and femur (thigh bone) to anchor the new graft inside the joint, restoring knee stability and function. After surgery the knee is protected in a knee brace.

What is the usual outcome of this surgery?

There will be a significant improvement in knee stability and function with most patients regaining a full or nearly full range of motion and being able to return to moderate or even vigorous activities. Approximately 80% of patients are able to return to their previous level of sport 9-12 months post-surgery.

What are the complications that can happen?

1. Neurovascular injury: Due to the proximity of important blood vessels and nerves in the back of the knee, there is a risk of injury to these structures during surgery.
2. Fracture: Bone tunnels created for graft placement can weaken the femur or tibia, leading to potential fractures.
3. Venous thromboembolism (DVT/PE): Deep vein thrombosis and pulmonary embolism can occur postoperatively. Incidence rates for DVT and PE are about 1–2%.
4. Surgical site infection: The infection rate after PCL reconstruction is low (<1%).

What is the usual timeline and recovery after this surgery?

1. Length of hospital stay: 1-3 days
2. Total recovery period: 6 months
3. Return to driving: 6-8 weeks
4. Return to sports: 6-9 months
5. Return to work: Desk based job – 2-3 weeks

Manual job – from 3 months