Lateral view

Axial view

PCL tibia insertion

• PCL attachment on fovea/facet
• Attachment is 10-15mm distal to joint line
• Posterior horn of medial meniscus being the most anterior to PCL

Knee extension PM bundle more vertical while in flexion AL bundle more vertical

Right knee: LCL

Left knee: Popliteus posterior view

Left knee: Popliteus lateral view

Non-contact injury mechanism:
Knee hyperextension
↑ Flexion

Motor vehicle accidents common cause of PCL injury: posteriorly directed force with the flexed knee during dashboard injury with a posterior-directed force applied to the tibia.
Athletic injury: most commonly a fall on the flexed knee with a plantarflexed foot and hyperflexion of the knee.

The PCL and posterior capsule can also be torn by a hyperextension mechanism.

PCL clinical assessment: Anterior and Posterior drawer tests are used for testing ACL & PCL respectively. Make sure the knee is in an anatomic position (reduce any subluxation) before performing either test.

Common meniscus tear patterns

PCL injury may be related to knee dislocation​

Non-surgical treatment

• Isolated Grd 1-2
• Strengthening with ROM knee exercises
• Progressive return to sport after completing battery of test protocols

Surgery

• Failed conservative treatment for low grade PCL tear with instability
• Functional instability in a PCL deficient knee
• Multiligamentous knee injury with knee instability

Quadriceps muscle

Hamstring muscle

The antagonistic action of the hamstring and extensor muscle groups allow knee flexion and extension. The intact cruciate ligaments provide stability thereby preventing tibia translation. Rehabilitation include strengthening these muscle groups around the knee

• Reconstruct the PCL with graft and attach it to its anatomic sites
• Graft selection: Allograft or autograft, single bundle or double bundle PCL reconstruction

Femur fixation

• Inside out or outside in technique
• Screw fixation or suspensory fixation (endobutton)

Tibia fixation

• Transtibial fixation
• Tibia inlay

Single bundle

• Single bundle PCL the proximal-distal attachment location in the femur rather than the anterior-posterior location influences graft function.
• For a single bundle PCL recon: graft should be placed in AL or central position. Avoid PM position due to ↑ graft straining with ↑ the risk of failure.
• For single-bundle PCL: Anterior femoral tunnel position provides less posterior tibia translation than posterior tunnel position.

Double bundle

• For double-bundle PCL recon: anterior & posterior tunnel position also affects the degree of posterior tibia translation, with anterior position causing less posterior translation.

Transtibial fixation

Tibia inlay fixation

Knee ROM brace allow setting of specific knee range of motion (ROM)

Hip extensor muscle strengthening with knee in extension using resistance band