POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
- Method
- Arthroscopic reconstruction of the posterior cruciate ligament
- Duration
- 90 to 120 minutes
- Recovery time
- 9 to 12 months
Posterior cruciate ligament reconstruction
Posterior cruciate ligament reconstruction is a complex reconstructive procedure for ruptures of the posterior cruciate ligament (PCL). The PCL is responsible for stabilising the tibia against the femur in the backward direction and is an essential structure for the biomechanical integrity of the knee joint.
Injuries of the posterior cruciate ligament often occur as a result of road accidents or sporting trauma (for instance a dashboard injury) and, left untreated, can lead to chronic instability and to consequent damage such as osteoarthritis of the knee. During the operation an autologous tendon graft (for instance from the quadriceps or patellar tendon) is usually introduced arthroscopically.
How the operation proceeds
The operation is carried out in a minimally invasive way under arthroscopic control. Once the femoral and tibial bone tunnels have been prepared, the tendon graft is introduced through what is known as a transportal or an outside-in approach. Modern implants such as interference screws or cortical buttons are used for fixation. The aim is to recentre the tibia anatomically under natural tension.
- Anatomical placement of the bone tunnels (the PCL footprint)
- Stable fixation with reduced posterior translation
- Optional additional techniques: anterolateral augmentation, double-bundle technique
Rehabilitation after a PCL reconstruction
Aftercare following a PCL reconstruction has to be planned particularly carefully in order to avoid overstretching the graft. Loading too early or too heavily can put the success of the treatment at risk.
Phase I (0-6 weeks): protective phase
- Knee orthosis at 0-30° of flexion, positioned with posterior support
- Partial weight-bearing at 10-15 kg, no active flexion against gravity
- CPM splint (continuous passive motion)
- Cooling, lymphatic drainage, isometric activation of the quadriceps
Phase II (6-12 weeks): mobilisation and building up muscle
- Increasing flexion step by step to 90°
- Progressive loading, first active exercises without resistance
- Balance training and proprioceptive stimulation
- Avoiding posterior translation of the tibia (for instance hamstring curls)
Phase III (from week 12): functional integration
- Building up strength, co-ordination and endurance
- Sport-specific training after about 6 months
- Return-to-sport tests for individual clearance
Our PCL specialists
Experienced specialists for posterior cruciate ligament reconstruction and cruciate ligament surgery
