Posterior Cruciate Ligament (PCL) Tear

What is a Posterior Cruciate Ligament (PCL) Tear?

The PCL (posterior cruciate ligament) is connected to the shinbone and thigh bone and keeps the shinbone forward of the thigh bone. The PCL is located inside the knee around the knee joint and is behind the ACL (anterior cruciate ligament).

PCL injuries are usually incurred while directly hitting or falling on the knee while it is bent.  PCL injuries can also occur when severe torquing of the knee occurs.  Many athletes and those that are physically active have PCL injuries. It can also happen during an auto accident or blunt force trauma.

At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, we take our time with each patient to listen and present options that are customized to their specific needs. Dr. Charles E. Stewart specializes in PCL reconstruction and repair.

Knee Ligaments 

  1. Collateral Ligaments

Collateral ligaments control sideways movements of the knee. These two ligaments are located on the inside and outside of the knee. The medial is on the inside, and the lateral is outside the knee joint.

  1. Cruciate Ligaments

Cruciate ligaments control the knee’s back and forth motions and prevent rotational movements. These ligaments are located on the inside of the knee joint and as mentioned previously, form an “X” with the anterior ligament in the front of the knee and the posterior behind.

What types of PCL Injuries Are There? 

PCL injuries are phased into 4 grades. PCL issues can be both acute or chronic. Acute PCL conditions occur when there is an accident or injury.  Chronic PCL injuries involve an injury that lingers and has developed over time due to an injury. Chronic and acute PCL injuries are progressive in nature if left untreated.

  • Grade 1: Partial tear
  • Grade 2: Partial tear with some instability and pain caused by stretching and loose PCL fibers
  • Grade 3: Complete tear, instability, and pain
  • Grade 4: Complete tear with other damage to knee and surrounding tissues

Posterior Cruciate Ligament (PCL) Tear Symptoms: 

Depending on the severity of the injury, PCL tear symptoms can range from mild to extensive. If there are other ligament injuries or tears, the symptoms may be wide-ranging.

The following symptoms are common with PCL tears:

  • Knee pain
  • Swelling and inflammation
  • Difficulty walking
  • Tenderness to touch
  • Knee joint instability 
  • A sensation of wobbling and being off balance in the knee
  • Difficulty bearing weight on the knee


Posterior Cruciate Ligament (PCL) Tear Causes 

The causes of PCL injuries and tears can vary depending on the patients age, overall health, and activity level. Below are a few common causes of PCL injury:

  • Motor vehicle accidents (bent knees hit dashboard)
  • Contact sports (tackled, direct hit when knee is bent)
  • Hitting shins with or on an object
  • Knee torquing and overextension 

Risk Factors for Posterior Cruciate Ligament (PCL) Tear Condition

What puts patients at greater risk of PCL tears or injury?  PCL tears can happen to anyone at any age, but mostly occurs in younger teens or adults that are very active or play sports.  The following are few examples of what might put individuals at high risk:

Certain sports make people more susceptible to PCL tears. These can include football, basketball, soccer, and gymnastics; however, getting hit in the knees or falling on the knees is often a cause of PCL tears and injuries.  For individuals that have balance issues or have careers where they might be more susceptible to falls, these can be risk factors for PCL injury. 

For individuals that have other knee injuries, the weakness in the knee joint can cause a greater risk for PCL tears. 

How is Posterior Cruciate Ligament (PCL) Tear Diagnosed?

The onset of pain, swelling, stiffness and instability will be a clear sign that something is wrong with the knee. Seeking medical care is crucial. The earlier PCL Tears are diagnosed and treated, the better the outcome for the patient.  

Along with a physical examination, orthopedic surgeons will also utilize diagnostic testing, which may include X-rays, magnetic resonance imaging (MRI), and ultrasound.

Posterior Cruciate Ligament (PCL) Treatment

Depending on any other coexisting knee injury, the health of the patients, and the age of the patient, treatment may vary. PCL tears will not heal on their own and require surgery to rebuild it with grafted tissue and to close the ligaments back together; however, for the elderly and patients that live inactive lifestyles, conservative treatment may be sufficient. This includes resting, icing, elevating, bracing, physical therapy, pain medications, and limiting weight-bearing.

Surgical intervention is recommended for PCL tears that are complete and causing ongoing instability. Grafts are often taken from the patient’s tendons, from the hamstring or quadriceps, etc. These will help to rebuild the PCL, and new tissue will naturally grow over time and cause it to become more stable.

PCL tears are usually performed via arthroscopic surgery. Arthroscopic surgery is a minimally invasive procedure utilizing tiny instruments through small incisions that is under fluoroscopy. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the knee joint. 

With decades of experience, at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine all of our surgeons are board certified and fellowship trained. We offer you the best treatment options and care.

We provide excellent medical care in a warm, caring, comfortable environment, where patients are treated efficiently, effectively, and as if they were the only patient. Let us get you back in your game.


1. Can a posterior cruciate ligament heal itself?

Grade 1 and 2 PCL injuries can heal with conservative treatment.  If there are no other combined injuries, resting, protecting the knee, icing it and elevating the knee can help. There are also other conservative methods that orthopedic surgeons and physical therapists can do that help the injury recover with optimal results.

2. Why does the back of my knee hurt when I walk?

Because the PCL is located within the back of the knee, if it is injured, it will cause pain in that area.  If the pain is severe, it may feel as if the entire knee is painful due to permeating pain, or additional injuries or tears within the knee or leg.

3. When do you need PCL surgery?

If other ligaments were injured or torn, or if the patient has chronic instability, limited range of motion and pain, surgery may be necessary. This type of knee surgery is usually performed with a minimally invasive technique through arthroscopic treatment.

Focusing On You

As healthcare is ever changing, Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, is doing things differently…

  • Christopher R. Sforzo, M.D. is a board certified orthopedic surgeon and fellowship trained in hand and upper extremity surgery. He provides expert care in the treatment of problems involving the shoulder, arm, elbow, forearm, wrist and hand. He performs many procedures using minimally invasive techniques includi
  • Christopher L. Dillingham, M.D. is a board certified orthopedic surgeon and fellowship trained in hand, shoulder, and arm surgery. He specializes in the treatment of problems with rotator cuff disorders, carpal tunnel syndrome and nerve injury, joint replacement, arthritis surgery, fracture repair, foot and ankle
  • Charles E. Stewart M.D. is a board certified, Johns Hopkins fellowship-trained orthopedic surgeon specializing in adult complex reconstruction of the lower extremity. His specialties include, lower extremity sports injuries, meniscal injuries, partial knee replacement, total hip and knee arthroplasty (replacement), as
  • Philip A. Meinhardt, M.D. is a board certified orthopedic surgeon and fellowship trained spine surgeon. He specializes in adult spinal surgeries including reconstruction of spinal deformities, minimally invasive/microscopic spinal procedures, decompression, spinal instrumentation, fusion procedures and microscopic cer



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