PCL (posterior cruciate ligament) reconstruction is a surgical procedure to replace a torn PCL — the ligament that prevents the shinbone from sliding backwards beneath the thighbone. It is less common than ACL reconstruction and is performed when instability is significant.
The operation is performed arthroscopically. A graft (usually from a donor tendon — allograft — or from the patient's own tendons) is used to reconstruct the ligament. Tunnels are drilled in the thighbone and shinbone, and the graft is passed through and fixed in position. The operation takes one and a half to two hours.
PCL reconstruction is recommended for patients with symptomatic posterior knee instability that interferes with daily activities or sport, particularly when combined with other ligament injuries (multi-ligament knee injury). Isolated PCL tears are often managed non-operatively.
Many isolated PCL tears can be managed with intensive quadriceps rehabilitation and bracing. The PCL has some capacity for healing, unlike the ACL. Surgery is reserved for persistent instability despite rehabilitation.
MRI and sometimes stress X-rays to confirm the diagnosis and assess associated injuries. Pre-operative physiotherapy to optimise quadriceps strength.
The aim is to restore posterior stability of the knee and reduce symptoms of instability. Most patients achieve improved stability and function, though results are somewhat less predictable than ACL reconstruction.
Loss of knee flexion is the most common complication. Aggressive physiotherapy is important.
Discomfort at the graft harvest or fixation sites.
Some degree of posterior laxity may persist despite reconstruction.
The reconstructed ligament may stretch or rupture.
The popliteal artery and nerve run close to the PCL and are at risk during surgery.
DVT despite preventive measures.
Joint infection.
General or spinal anaesthesia with a nerve block.
A brace locked in extension is worn for four to six weeks. Crutches for six weeks. Physiotherapy begins immediately with a focus on quadriceps strengthening. Jogging at four to six months. Return to sport at nine to twelve months. Full recovery takes twelve months.
Regular reviews at two weeks, six weeks, three months, six months, and one year.
The PCL has better healing potential than the ACL, and many patients function well with a PCL-deficient knee after quadriceps strengthening.
Yes, the PCL is deeper and closer to major blood vessels and nerves, making reconstruction technically more demanding.