Overview
what it is and why it mattersThe posterior cruciate ligament (the PCL) is the strongest ligament in your knee. It sits deep inside the joint and runs from the back of your tibia up to the inner side of your femur. Its job is to keep your tibia from sliding backward relative to your thigh. PCL tears most often happen from a direct hit to the front of a bent knee: a dashboard injury in a car wreck, or falling onto a bent knee with the foot pointing down. They are less common than ACL tears, and they more often happen on their own without other ligament injuries.
Compared to an ACL tear, an isolated PCL tear actually does better on its own. Many people with a partial PCL tear get back to full activity with physical therapy alone, no surgery. The story changes when the PCL is torn together with other ligaments. Those combined injuries are more disabling and usually need surgical repair.
Symptoms
what you may noticeSwelling and pain at the back of the knee after a direct hit, commonly a dashboard impact or a fall onto a bent knee. Unlike an ACL tear, a PCL tear may not feel dramatic at first; many people walk off the field before realizing something is wrong.
The knee may feel vaguely unstable going downhill or down stairs, and you may notice a dull ache in the back of the knee that worsens with activity. Over time an untreated PCL tear can lead to pain in the front of the knee or on the inner side as other structures compensate for the missing ligament.
Diagnosis
exam first, imaging secondPain and swelling at the back of the knee after a direct blow. A focused physical exam of the knee checks for excess backward motion of the shin compared to the other side, and for a visible backward sag of the shin when the knee is bent. An MRI confirms the tear and looks for any other ligaments or cartilage that might be hurt at the same time.
How We Treat It
what we try first, in orderHere is the encouraging part: an isolated PCL tear often does well without surgery. Most people with a partial tear and no other ligament damage get back to their sport with rehab alone. The steps below are the order we usually work through, each one builds on the one before it.
1
Bracing
A specialized PCL brace pushes the tibia forward, counteracting the backward sag the torn ligament would otherwise allow, while the knee heals.
2
Physical therapy
Building strong quadriceps is the centerpiece of PCL rehab. Strong quads pull the tibia forward, which is exactly what a torn PCL can no longer do well, so they compensate for the missing ligament during walking, running, and sport.
3
Activity modification
Most people with a partial PCL tear, with no other ligament damage, get back to their sport with rehab alone. No surgery needed.
Surgical Options
if non-operative care isn't enoughWe consider surgical reconstruction for complete PCL tears, for PCL tears that come together with other ligament injuries (especially the back-outside corner of the knee or the ACL), and for any PCL tear where the knee still feels unstable after a real trial of physical therapy.
PCL reconstruction
A tendon graft replaces the torn PCL; often performed at the same time as repair of other injured ligaments around the knee.
Learn about this procedure →Multi-ligament knee reconstruction
Complex reconstruction for knee dislocations and combined ligament injuries.
Learn about this procedure →Frequently Asked
questions we hear in clinicWill I need surgery?
Often not. An isolated PCL tear actually does better on its own than an ACL tear does. Many people with a partial tear and no other ligament damage get back to full activity with physical therapy alone. The picture changes when the PCL is torn together with other ligaments, those combined injuries are more disabling and usually do need surgical repair.
How does a PCL tear happen?
Most often from a direct hit to the front of a bent knee. The classic examples are a dashboard injury in a car wreck, or falling onto a bent knee with the foot pointing down.
How is it different from an ACL tear?
PCL tears are less common than ACL tears, and they more often happen on their own without other ligament injuries. They also may not feel as dramatic at first, many people walk off the field before realizing something is wrong.
Why does rehab focus so much on my quadriceps?
Building strong quadriceps is the centerpiece of PCL rehab. Strong quads pull the tibia forward, which is exactly what a torn PCL can no longer do well, so they compensate for the missing ligament during walking, running, and sport.
When would surgery be considered?
We consider surgical reconstruction for complete tears, for PCL tears that come together with other ligament injuries (especially the back-outside corner of the knee or the ACL), and for any PCL tear where the knee still feels unstable after a real trial of physical therapy.
Do I need an MRI?
An MRI confirms the tear and looks for any other ligaments or cartilage that might be hurt at the same time. The exam comes first: your provider checks for excess backward motion of the shin and for a visible backward sag of the shin when the knee is bent.
Providers Who Treat PCL Tear
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: