Have you ever felt a popping sensation in your knee? Maybe you’re aware that you have minor knee troubles, but not enough to interfere with your daily activities. Or perhaps you have constant swelling and find it difficult to put weight on your leg. Any of these symptoms can indicate a PCL ligament tear.
While PCL tears aren’t all that common—comprising less than 20% of knee ligament injuries—they are painful and can lead to osteoarthritis in the knee if not addressed.
Therefore, it’s important to be aware of the symptoms of PCL tears so you can take immediate action for a full recovery. Keep reading to find out the most common PCL tear symptoms and signs and discover the best PCL tear treatment options available.
The PCL works to stabilize the knee, preventing the lower leg from moving out of its correct position. (Image Reference)
The posterior cruciate ligament (PCL) is a band of tough tissue that connects bones within the knee. The posterior cruciate ligament function is to connect the thigh bone to the shin bone.
Both the PCL and the ACL (the anterior cruciate ligament) work together to stabilize the knee joint when moving forward or backward, preventing too much lateral movement. The PCL, in particular, keeps the lower leg from moving too far back relative to the upper leg, especially when the knee is bent.
The cruciate ligaments cross the knee to form an X, with the PCL located at the back of the knee and the ACL in front. The PCL is stronger than the ACL and is therefore injured less often. However, PCL tears can and do happen, causing pain, knee instability, and immobility.
What is a PCL Tear?
ACL and PCL tears may occur when some of the fibers that make up the ligaments become stretched, torn, or damaged due to overuse or sudden trauma.
PCL tears can range from mild to severe and are classed as:
Grade 1 PCL Tear: a partial PCL tear
Grade 2 PCL Tear: a partial PCL tear that is looser than a Grade 1 tear
Grade 4 PCL Tear: damage to the PCL, in addition to damage to another knee ligament, such as the ACL
Causes and Risk Factors for PCL Tears
Tears to the posterior cruciate ligament can happen if you:
Hit your shin bone hard just below the knee
Fall on a bent knee
Twist the knee suddenly and forcefully when the feet are on the ground
Suddenly change direction or speed
Turn abruptly
Overextend the knee
Risk factors for injury to the PCL include:
Playing Contact Sports
If you play football or soccer, you’re more likely to tear your posterior cruciate ligament. This is because the risk of falling or being tackled while on a bent knee is higher than in other sports. Baseball and skiing are other sports that increase the risk of a PCL tear.
Motor Vehicle Collisions
A form of dashboard injury, PCL tears can happen if you bang your knee against the dashboard. In this case, the shin bone is pushed below the knee, tearing the ligament.
PCL Tear Symptoms
You may be asking, “What does it feel like when you tear your PCL?” While signs and symptoms vary depending on the severity of the damage, the typical symptoms of PCL tear include:
Pain in the knee
Feeling that your knee is too weak to support you
Swelling that usually occurs quickly following PCL injury
Stiffness in the knee
A limp or difficulty walking
A popping sound upon injury (although this is more common with ACL tears)
Pain that spreads to the calf area over time
Diagnosing a PCL Tear
Your doctor will usually diagnose injury to your posterior cruciate ligament during a physical examination, which includes taking details of your medical history. Your doctor may also require imaging tests.
Medical History and Physical Examination
The first step in PCL diagnosis is a discussion of your symptoms. The doctor may ask when you first noticed the injury, what you were doing when the injury occurred, and what symptoms you are currently experiencing.
They will also carry out a physical examination to look for signs of PCL tear, which involves checking the structure, position, and flexibility of your knees. You may be asked to walk in a line so the doctor can check your gait.
Posterior Cruciate Ligament Test
Your doctor may perform a simple test, also known as a PCL injury test or PCL tear test.
The test involves lying on your back with your knee bent. The doctor will press on the upper portion of your shin to check for knee movement. Any abnormal movement deemed indicates a tear to the PCL.
Imaging Tests
If there is any doubt about the diagnosis of a PCL tear following the physical examination and PCL tear test, your doctor may order one or more of the following:
PCL Tear MRI Scan
Using radio waves and magnetic fields, an MRI scan reveals tears and other damage to ligaments and cartilage.
X-Rays
While X-rays are unable to highlight PCL tears, they can uncover avulsion fractures—injuries that occur when ligaments tear off pieces of bone. X-rays are especially important to diagnosing chronic or slow-healing PCL injuries.
Arthroscopy
This surgical procedure, which involves inserting a small camera into the knee joint, can uncover the extent of a knee injury.
PCL Tear Treatment
Several treatment options are available for PCL tears. Your doctor will help you decide which treatment regimen is right for you based on the severity of your injury and how long you have had it. In most cases, non-surgical PCL tear treatments are sufficient to encourage full recovery.
1. RICE
The RICE protocol is the initial treatment used to relieve symptoms of PCL tear. It is most effective when implemented within the first 72 hours following injury.
Rest. Resting your knee gives it time to heal and protects it from further injury. Whenever possible, avoid putting weight on the knee as this can lead to further damage and inflammation.
Ice. Placing an ice pack on your knee can help to reduce pain and inflammation. Ice can be used for up to fifteen minutes every four hours, or as required.
Compression. Using an elastic compression bandage is a highly effective way to reduce the pain and swelling associated with PCL tears.
Elevation. Raising the knee above heart level helps restrict blood flow and decrease swelling.
2. PCL Knee Brace
A PCL knee brace—a type of orthotic device—helps maintain the proper alignment of the knee. Braces relieve pain, prevent further injury, and encourage healing.
There are several varieties of braces available. Consult your doctor to decide which type will be most beneficial to your healing process. Popular options include a universal knee brace, which provides support and compression and prevents dangerous lateral movement.
A wraparound knee brace is fully adjustable to provide the perfect amount of compression and support. (See Product )
More severe cases may require stronger support, as found in a hinged knee brace, which further limits range of motion to prevent damage to the weakened ligaments.
Hinged knee braces provide the highest level of stability and support, making them perfect for severely injured joints. (See Product )
When your PCL tear has healed, you can continue to wear the brace during physical activity for extra support and to avoid re-injury. A compression sleeve is especially useful during and after activity. Compression relieves pain, reduces swelling, and improves circulation to benefit the overall health of your knee.
Compression reduces swelling and improves circulation, which improves mobility and relieves pain associated with a PCL tear. (See Product )
3. Crutches
As part of your rehabilitation program, you may need to use crutches to avoid putting weight on your knee. As time passes and your knee heals, you can gradually begin to walk with more weight on the leg.
Your doctor may also recommend a knee walker as an alternative to crutches.
A knee walker is often easier to use and more convenient than crutches, while providing the same benefits. (See Product )
4. Physical Therapy
Once the swelling in your knee has gone down, you may need to work with a physical therapist. If you have had PCL tear surgery, physical therapy won’t start until 7 to 28 days following your procedure.
The therapist can provide a tailored program of PCL injury exercises and stretches to improve strength, mobility, and flexibility in your knee. They may also suggest you walk or run in a swimming pool or on a treadmill, or engage in specific training techniques based on your preferred activities.
While you are healing, stick to low-impact exercise options, such as gentle yoga, chair exercises, and tai chi.
5. PCL Injury Exercises
A program of stretches and exercises for PCL tears will help to improve your mobility and flexibility.
Some of the following exercises may be especially helpful for PCL tear recovery:
Heel Sliders and Quad Sets
These two activities are great for loosening up stiff knee joints, strengthening the quad muscles, and increasing range of motion.
Seated Hamstring Stretch
The hamstrings are often tight following a knee injury. Use this simple exercise to stretch them out so they can better support the knee joint.
Ball Wall Squat
After several weeks of PT, your therapist may recommend this exercise. Using a ball and leaning against a wall, you will slowly and gently squat, moving farther down the wall gradually as strength increases.
Always check with your doctor or physical therapist before beginning any new exercise regimen.
6. Medication
A PCL tear that is causing severe pain or swelling may benefit from over-the-counter anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen.
NSAIDs should always be taken according to the packet instructions and should not be used long-term, as adverse effects include stomach bleeding and gastrointestinal irritation. Consult your doctor before beginning any new medications.
7. PCL Tear Surgery
Most people who experience a PCL tear, particularly those who have a partial PCL tear, do not require surgery.
However, severe cases may require surgical intervention, especially if:
Other knee ligaments are torn
There is cartilage damage
A bone is broken
The knee is persistently unstable
Surgery may be minimally invasive, using an arthroscope. It may also be “open,” involving a large incision into the knee. Consider all the potential benefits and risk factors, and be sure you and your doctor have exhausted all options before resorting to surgery.
The time required for a full PCL tear recovery varies from person to person and depends on several factors, including:
The severity of the tear
Whether there is damage to bones or other ligaments within the knee
Your general health and fitness levels
Lifestyle factors
Time passed before treating the tear
Treatment interventions used
If other structures in the knee are damaged, there is a higher risk of long-term knee pain and instability. Untreated PCL tears can increase the risk of arthritis in the knee.
However, most cases of PCL tear eventually heal with the use of minimally invasive treatments, although it can take anywhere from several weeks to several months to notice improvements. If you have to undergo PCL tear surgery, you may need 6 to 12 months of recovery time.
The more quickly you respond to your PCL tear, the better your chances of a speedy recovery. Those who have mild tears and use the RICE protocol within 72 hours of injury generally recover faster than those who delay treatment, don’t use adequate recovery techniques, or have severe injuries.
How to Prevent a PCL Tear
Prevention is always better than the cure! While not all cases of PCL tears can be avoided, taking the following steps can reduce the risk of tearing your posterior cruciate ligament:
Wear a supportive PCL knee brace when working out or playing contact sports.
Always warm up properly before exercising.
Use the exercises listed above to strengthen the ligaments and muscles in the knee and leg.
Learn proper form and technique when engaging in activities that increase the risk of PCL tears.
If you suffer from chronic or recurrent injury to the PCL, consider implementing low-impact exercise routines, such as Pilates or pedal exercise.
LCL, ACL, MCL, and PCL Tears
The PCL isn’t the only ligament that supports the knee joint. As mentioned earlier, the ACL, or anterior cruciate ligament, works with the PCL to maintain proper alignment of the knee.
But there are two other ligaments that also help connect the shin bone to the thigh bone and play a role in knee alignment and stability: the lateral collateral ligament (LCL) and the medial collateral ligament (MCL). Although located outside the knee joint, the LCL and MCL stabilize the outer knee and inner knee, respectively.
Tears can occur in any of these ligaments, and the cause is typically the same: a hard knock or blow to the knee that strains or tears the ligament. While treatment for all of these tears is similar, it’s important to see a doctor for a correct diagnosis and targeted treatment plan.
Treating a PCL Tear
The importance of our knees for our overall mobility and physical functioning can’t be overstated. That’s why taking care of the four knee ligaments—in addition to the leg bones and muscles—is imperative for health and happiness.
If you think you have a PCL tear, employ the RICE protocol and make an appointment with your doctor immediately.
The PCL works to stabilize the knee, preventing the lower leg from moving out of its correct position. (
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