Posterior Cruciate Ligament Reconstruction (PCL)
A surgical procedure to restore stability and function to the posterior cruciate ligament of the knee
The PCL is one of the main stabilising ligaments of the knee, connecting the femur (thighbone) to the tibia (shinbone). Injuries to the PCL often occur due to direct trauma, such as a fall onto a bent knee or a car accident where the shin is forced backward.
Common Reasons for PCL Reconstruction Surgery
- Complete or severe PCL tears that do not heal with non-surgical treatments.
- Chronic instability or ongoing pain caused by a PCL injury.
- Combined ligament injuries involving the ACL, MCL, or LCL, requiring comprehensive knee reconstruction.
The goals of PCL reconstruction are to stabilise the knee, reduce pain, and restore functional movement.
Preparation for Surgery
A thorough evaluation by Dr Ben McGrath is essential to plan the procedure. Imaging studies, including X-rays, MRIs, or CT scans, are used to assess the severity of the injury and determine the most appropriate surgical approach.
Key Steps in Preparation:
- Consultation: Dr McGrath will explain the procedure, its potential benefits and risks, and address any questions.
- Pre-Surgical Instructions: Patients may need to fast before surgery and adjust medications, such as stopping blood thinners.
- Prehabilitation: Strengthening the muscles around the knee before surgery may enhance recovery.
- Lifestyle Adjustments: Maintaining a healthy weight and stopping smoking can optimise surgical outcomes and recovery.
What Happens During the Surgery?
PCL reconstruction is typically performed under general anaesthesia and often utilises minimally invasive techniques.
Surgical Steps:
- Incisions: Small incisions are made to access the damaged ligament.
- Graft Preparation: A graft, often taken from the hamstring, patellar tendon, or a donor source, is prepared to replace the damaged PCL.
- Tunnel Creation: Tunnels are drilled into the femur and tibia to secure the graft.
- Graft Placement and Fixation: The graft is positioned to mimic the natural PCL and secured using screws or other fixation devices.
- Closure: The incisions are closed with sutures or adhesive strips, and the knee is bandaged for protection.
The procedure typically takes 1 to 2 hours, depending on the complexity of the injury.
Understanding the Risks
PCL reconstruction is a safe and effective procedure, but like any surgery, it carries potential risks:
- Infection: At the incision sites or within the joint.
- Graft Failure: Rarely, the reconstructed ligament may not function as expected.
- Swelling and Stiffness: Temporary inflammation or reduced range of motion.
- Blood Clots: Rare but possible in the lower limbs.
- Nerve or Vessel Injury: Extremely rare but a potential risk during surgery.
Dr McGrath employs advanced surgical techniques and follows strict safety protocols to minimise these risks.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Mild to moderate discomfort can be managed with prescribed medications and regular icing.
- Assistive Devices: Crutches and a knee brace may be required to protect the reconstructed ligament during the initial recovery phase.
- Discharge Instructions: Patients will receive clear guidance on caring for the surgical site, activity restrictions, and follow-up appointments.
Rehabilitation and Recovery
Recovery from PCL reconstruction involves a structured rehabilitation program tailored to the patient’s needs:
Phase 1: Early Recovery (Weeks 0–6)
- Goals: Protect the graft, reduce swelling, and restore range of motion (ROM).
- Activities: Partial weight-bearing with crutches, gentle ROM exercises, and cryotherapy.
Phase 2: Strength and Mobility (Weeks 6–12)
- Goals: Regain strength, stability, and mobility in the knee.
- Activities: Physiotherapy for strengthening the quadriceps and hamstrings, light cycling, and balance exercises.
Phase 3: Advanced Recovery (Months 3–6)
- Goals: Restore full function and prepare for daily activities or sports.
Activities: Progressive resistance training, functional drills, and agility exercises.
Long-Term Outcomes
PCL reconstruction may help stabilise the knee, alleviate pain, and improve overall function. Long-term success depends on:
- Adherence to rehabilitation protocols.
- Regular follow-up appointments to monitor progress.
- Maintaining a healthy lifestyle, including low-impact activities to support joint health.
Most patients experience significant improvements in knee stability and mobility, enabling them to return to their desired activities with confidence.