KneeŞişli, Istanbul
PCL injury treatment
The posterior cruciate ligament prevents the shin bone from sliding backward on the thigh bone. It is injured far less often than the ACL, and most isolated injuries do well without surgery.
Also known as: PCL tear, posterior cruciate ligament rupture
What is it?
The PCL is the strongest ligament in the knee and injuring it requires considerable force. The typical mechanism is a direct blow to the front of the shin with the knee bent — striking the dashboard in a road accident or falling onto a bent knee in sport are the commonest examples.
Unlike an ACL injury, symptoms can be more insidious. Patients often do not describe clear giving way; instead they report deep discomfort in the knee, difficulty descending stairs and pain when kneeling. Diagnosis can therefore be delayed.
For isolated PCL injuries conservative treatment is the first option and results are good. Quadriceps strengthening sits at the centre of rehabilitation: this muscle pulls the shin bone forward and partly takes over the PCL's role. Hamstring work is limited early on because it acts in the opposite direction.
Symptoms
- Deep, dull pain behind the knee
- Difficulty descending stairs and walking downhill
- Marked discomfort when kneeling
- A vague sense of instability, less obvious than with an ACL injury
- Moderate swelling after the injury
- The shin bone appearing to sit back relative to the thigh bone
- Increasing knee fatigue after long walks
Causes and risk factors
- A blow to the front of the shin with the knee bent
- Striking the dashboard in a road accident
- Falling onto a bent knee with the foot pointed down
- Forced hyperextension of the knee
- Direct blows in contact sports
- Falls from height
The assessment
The mechanism is explored in detail; a history of a blow to the shin strongly suggests the PCL. The posterior drawer test and the sag sign are assessed — the shin sitting back with the knees bent to 90 degrees is the typical finding.
Other ligament structures are also checked, since PCL injuries frequently occur with posterolateral corner injuries, a combination that changes management. Quadriceps strength and range of motion are measured.
Course of treatment
Weeks 0–4
Protection and extension
Swelling is controlled and full knee extension preserved. Hamstring contraction is limited early because it pulls the shin backward. Quadriceps activation begins immediately.
Weeks 4–12
Quadriceps-focused strength
Quadriceps strengthening is the centre of the programme, as this muscle partly takes over the PCL's function. Hip strength is developed in parallel and hamstring work added gradually.
Months 3–6
Functional loading
Stairs, squatting and single-leg control are trained, with balance and proprioception work added.
Month 6 onward
Return to sport
Running and cutting are added progressively. The decision to return depends on quadriceps strength reaching an adequate level relative to the uninvolved side.
How long does it take?
In isolated PCL injuries functional recovery is usually achieved in three to six months, with a programme of 14–20 sessions. Multi-ligament injuries and marked instability require surgical assessment. Quadriceps strength is the single most important determinant of outcome.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Numbness, coldness or absent pulses in the leg — possible vascular or nerve injury
- Obvious deformity — suspicion of knee dislocation
- Complete inability to bear weight
- Marked instability in more than one direction
- Fever, redness and warmth
Frequently asked questions
Does a PCL injury need surgery?
In most isolated injuries it is not needed and conservative treatment works well. Surgery is considered in multi-ligament injuries and where marked instability persists.
Why is hamstring training limited in the early period?
Hamstring contraction pulls the shin backward — the same direction the injured ligament resists. It is limited early on and added gradually as healing progresses.
Why is descending stairs difficult?
Descending stairs requires the quadriceps to work while lengthening under control and increases load on the knee. With PCL insufficiency this movement is markedly demanding, and it becomes noticeably easier as strength improves.
Kneeling is not possible — does this improve?
Usually yes. Kneeling forces the shin backward and stresses the injured ligament. As strength and control improve, the position gradually becomes tolerable again.
Methods used
Related conditions
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
No referral is required for assessment. Enquiries regarding PCL injury treatment may be submitted via WhatsApp; available dates and times will be provided in response.