PCL Surgery

Repair a common knee injury.

Pending Medical Review

Updated 6 December 2021

Whenever you confront a traumatic injury to your knee such as being involved in an automobile accident or falling, it may result in tearing some of the ligaments present inside your knee. The posterior cruciate ligament is one of those ligaments vulnerable to being torn during such type of traumatic injury. 

 

If your PCL is injured, your healthcare provider has to replace that torn part with a normal tissue taken from your own body (autograft or allograft). This process is known as posterior cruciate ligament surgery. As the aging process is associated with various deteriorating features, the success rate of this operation varies with age.

 

Regulating the to and fro motion of the knees, the posterior cruciate ligament is a diagonally running ligament that is present in the middle of your knee, assorting an intact connection between the posterior side of the femur with the front of the tibia. It is considered stronger than the anterior cruciate ligament; however, damage to the posterior cruciate ligament accounts for 20% of knee ligament injuries.

 

Its treatment differs according to the severity of the damage undertaken. Mostly, you may encounter mild to moderate pain and agony encountering this injury. Your doctor would recommend you some analgesics (painkillers) to mitigate the suffering and advise you to lessen your body movements to prevent further harm. However, suppose you are a sportsman or an employee where your job demands more ground-level work. In that case, your doctor may suggest you undergo surgery protocol as it may hamper complications.

Posterior Cruciate Ligament
Posterior Cruciate Ligament (PCL)

When is a PCL Surgery Necessary?

Posterior cruciate ligament injury is not as common as the rest of knee injuries and is considered a minor injury. Therefore, this impairment is usually difficult to rule out as it may happen to come across with other ligaments and tendon injuries. Undergoing surgery protocol is appreciated in the following circumstances:

  • Ligament tear is coupled with ripping up of the adjacent bone and cartilage
  • If more than one ligament is involved
  • If you are an athlete and wants to restart your professional work, you need a surgical operation.
  • Road accidents, especially when your knee hits the front board.
  • Hyper-stretching of the posterior cruciate ligament may happen to occur in sports injuries.
  • Miss stepping on a wet floor may cause your knee to twist or bend causing a ligament tear
  • Failure of other medical procedures like medication, physiotherapy, and bed rest to heal the cause

 

Besides the above-mentioned conditions for undergoing surgery protocol, the final decision for an operation depends upon the basis of a person’s age, workload level, economical state (whether he or she can afford this procedure), and symptoms.

 

Medication and rehabilitation techniques are recommended when the patient is old, living a sedentary lifestyle. But an adult person with a high daily activity status should not waste time lingering on bed rest and physiotherapy approach; rather, he should go for surgery to get back to daily life routine.

What is the Procedure for a PCL Surgery?

The basic approach for this surgery is similar to that of anterior cruciate ligament surgery. It is based on the implantation of a graft at the site of the torn ligament. Here the technique can either be an allograft (transplant of a tissue or an organ from one individual to another of the same species) or an autograft (transplant of a tissue or organ from your own body). The success rate of allograft increases with the increasing life span, however, the latter one is recommended for young athletic players.

 

The central focus of this surgery is to give small incisions with the aid of an arthroscope. It is an instrument used to observe the condition of an injured knee by using a narrow optic scope. The critical steps involved in this procedure are as follows:

  • After a thorough inspection of the injured site, an arthroscope shaver is used, and remnants of PCL are removed along with soft tissues around the thigh bone (femur) that would help insert the graft later on.
  • Whether an allograft or autograft, the donor piece is usually extracted from the patellar tendon or gracilis tendon.
  • The graft is placed inside a tunnel made on the tibia, and the attachments of PCL with the tibia are carried out.
  • As to prevent additional damage, sharp edge points on the site of exit of the tunnel should be made smooth.
  • After the graft has been fixed to a screw, it is pulled back tightly to eradicate any slack.
  • Staples are used for firm attachment with the tibia.
  • Suturing of the incision is done to prevent microbial infection.
Arthroscopic view of healthy ACL and PCL
Arthroscopic view of healthy anterior cruciate ligament and posterior cruciate ligament.

How Much Does PCL Surgery Cost?

The price of extractions varies depending on the clinic and the complexity of the case. Below is a list of prices you can expect to pay in various countries.

ACL Reconstruction Surgery Cost Table
Country Price
United States of America $24,707*
Mexico $3,500

*Price based on “What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients”, the closest analog available for PCL Surgery in the United States, and internal data from Apollo Medical Travel.

What Are the Risks Associated With ACL Surgery?

As each individual has different structural and physiological features different from each other, complications also vary according to that. Instability and knee rigidity are the most common complications. Other potential risks  associated with posterior cruciate ligament surgery are:

  • Infectious states (bacterial or viral)
  • Numbness and tingling of muscles
  • Graft rejection
  • Immunosuppressed state
  • Sedentary lifestyle with fewer muscle movements
  • Nerve damage
  • Persistent laxity

Conclusion

If you have encountered a traumatic injury and are suspecting symptoms of a ligament injury, it’s the right time to consult your doctor. He can assess your condition thoroughly. If there is severe posterior cruciate ligament injury and your professional work demands an energetic body status, he may advise you to start preparing for surgery protocols. The surgery would be conducted via arthroscopic technique by a multidisciplinary approach. 

It is advised to call your doctor when you feel discomfort following this surgery to manage any complications that may arise following the operation.

Additional Resources

Sources

  1. Dennis MG, Fox JA, Alford JW, Hayden JK, Bach BR Jr. Posterior cruciate ligament reconstruction: current trends. J Knee Surg. 2004;17(3):133-139. doi:10.1055/s-0030-1248211
    Read on PubMed
  2. Chen CH. Surgical treatment of posterior cruciate ligament injury. Chang Gung Med J. 2007;30(6):480-492.
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  3. Hammoud S, Reinhardt KR, Marx RG. Outcomes of posterior cruciate ligament treatment: a review of the evidence. Sports Med Arthrosc Rev. 2010;18(4):280-291. doi:10.1097/JSA.0b013e3181eaf8b4
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  4. Pache S, Aman ZS, Kennedy M, et al. Posterior Cruciate Ligament: Current Concepts Review. Arch Bone Jt Surg. 2018;6(1):8-18.
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  5. Matava MJ, Ellis E, Gruber B. Surgical treatment of posterior cruciate ligament tears: an evolving technique. J Am Acad Orthop Surg. 2009;17(7):435-446. doi:10.5435/00124635-200907000-00004
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  6. Zawodny SR, Miller MD. Complications of posterior cruciate ligament surgery. Sports Med Arthrosc Rev. 2010;18(4):269-274. doi:10.1097/JSA.0b013e3181f2f4c2
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  7. Wang SH, Chien WC, Chung CH, Wang YC, Lin LC, Pan RY. Long-term results of posterior cruciate ligament tear with or without reconstruction: A nationwide, population-based cohort study. PLoS One. 2018;13(10):e0205118. Published 2018 Oct 3. doi:10.1371/journal.pone.0205118
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  8. Bernhardson AS, DePhillipo NN, Daney BT, Kennedy MI, Aman ZS, LaPrade RF. Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury. Am J Sports Med. 2019;47(2):312-317. doi:10.1177/0363546518819176
    Read on PubMed

This article is intended for informational purposes only. It is not meant to be used as medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you have surrounding a medical condition. Never disregard professional medical advice or delay in seeking it as a result of anything you read on this Site. 

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