Posterior cruciate ligament reconstruction

PCL reconstruction is generally undertaken using a hamstrings tendon from the same patient, which is folded to produce an appropriate length and width.

Grading posterior cruciate ligament injuries

PCL injuries are graded on a scale of I-III.

• Quote from peer-reviewed paper:

  "....Grade I (partial tear) - 1-5mm posterior translation. Tibia remains anterior to femoral condyles....Grade II (complete isolated) – 6-10mm posterior tibial translation. A complete tear of PCL without another injury. Anterior tibia flush with femoral condyles....Grade III (complete PCL with combined capsular and/or Ligamentous injury) - > 10mm posterior tibial translation. Tibia posterior to femoral condyles which may indicate a concomitant capsuloligamentous injury....."

  Citation: Raj MA, Mabrouk A, Varacallo M. Posterior Cruciate Ligament Knee Injuries. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430726/

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What determines the decision to reconstruct a torn posterior cruciate ligament?

Isolated grade I or II PCL injuries are generally treated without surgery.

However, when more severe tears occur together with other ligament or meniscus injury, then surgery is indicated.

• Quote from peer-reviewed paper:

  "...Some studies have reported good outcomes after conservative treatment of partial PCL tears, while others have reported poor results at long-term follow-up with disabling symptoms and functional limitations...."

  Citation: Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018 Jan;6(1):8-18. PMID: 29430489; PMCID: PMC5799606.

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Surgical reconstruction of the PCL

The posterior cruciate ligament is comprised of two bundles.

The surgeon may decide on a 'single-bundle' reconstruction or may attempt to better restore the anatomy with a 'double-bundle' technique, using the hamstrings tendons harvested from the patient.

• Quote from peer-reviewed paper:

  "....Anatomic single-bundle PCL reconstruction....typically restores the larger anterolateral bundle....and represents the most commonly performed procedure....."

  Citation: Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018 Jan;6(1):8-18. PMID: 29430489; PMCID: PMC5799606.

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Forum discussions

• "PCL/PLC etc.. reconstruction - Am I really volunteering for this?"

  Patients discussing PLC and PCL issues.

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