Knee is a complex ellipsoid joint that is held together by four major stabilizing ligaments namely medial collateral ligament, lateral collateral ligament, anterior cruciate ligament & of course, posterior cruciate ligament. Posterior cruciate ligament is essential for stabilizing & preventing knee from bending back in an inappropriate way. PCL tears make up nearly 10% of injuries to knee ligaments. Injury to posterior cruciate ligament needs a powerful force. According to reports, most common reason which results in 60 percent of PCL injuries is a football player falling on a knee that is bent or a bent knee hitting a dashboard in a car accident. These injuries that tear PCL, often hurt some other cartilage in knee as well. Moreover, in certain cases ligament can also break out a piece of intrinsic bone. Posterior cruciate ligament surgery is an optimal solution for such nasty injuries.
What is Posterior Cruciate Ligament Surgery?
PCL is the greatest ligament in knee & stops the shin bone from moving too far backwards. This can be injured by a blow to front of upper shin. Posterior cruciate ligament surgery is a surgical procedure which is used to replace a torn posterior cruciate ligament & rebuild stability to the knee joint. Knee injuries can result into restlessness in knee joint, knee inflexibility that causes limping & thereby make it difficult for the patient to even walk properly. In such situations, PCL surgery can prove to be an effective solution.
Injury to posterior cruciate ligament can be caused due to various reasons. Few common causes of PCL injuries are listed below.
Sports lead to a majority of PCL injuries. These injuries are most commonly observed in the following sports.
- Stretching or pulling the ligament (hyperextension injury or twisting)
- Direct blow to front of the knee
- Simple misstep
- Falling directly on the knee during physical activity or sports
One should therefore take care of knees while performing vigorous exercise or during sporting activities.
Unlike ACL injuries, most patients do not hear or feel any popping sensation in knee after PCL injury. Patients often think they just have minor knee pain. They may try to carry on with their daily normal routine activities. However, noticeable symptoms that can develop due to PCL injury include the following.
Over a large span of time, posterior cruciate ligament tear may lead to osteoarthritis in the knee joint.
In order to correctly diagnose PCL injury, orthopedic surgeons may evaluate the patient on the basis of following steps.
- Difficulty in walking properly
- Mild to severe swelling
- Pain with swelling that occurs quickly & steadily
- Strain bearing weight on the knee
- Instability of knee joint
Once PCL injury has been properly diagnosed, posterior cruciate ligament surgery may be recommended to patients depending upon the severity of injured knee.
Injury to posterior cruciate ligament can result in mild to severe damage. Doctors classify these PCL injuries in enumerated groups.
- History of Patient – Doctors will ask patients some details like when did this incident occur & was it while playing a sport or traveling in a car. Orthopedic surgeons may judge the patients by asking some significant questions like the ones mentioned below.
- If patient’s knee was straight, bent or twisted when it was injured
- How patient’s knee felt after injury
- If they had clear symptoms since they were injured
- Physical Examination – During general test for PCL injuries, doctors may ask patients to lie on their back with a bent knee. While examining their knee, doctors press against the upper shin. Any abnormal knee movement during this primary evaluation test suggests PCL injury.
- Imaging – X-rays can help in confirming PCL injury. They can identify pieces of bone that may have broken loose from knee trauma.
- Magnetic Resonance Imaging – This is a most reliable test designed to create better images of PCL tear. MRI test is able to find precise location of a tear & the amount of damage to bones.
PCL injuries can be acute or chronic. Acute PCL issues are due to an impulsive injury while chronic problems involve an injury that develops over a long period of time. However, posterior cruciate ligament tears also have the potential to heal on their own.
When patients decide to go with posterior cruciate ligament surgery to repair the torn posterior cruciate ligament, they will need to prepare for it mentally first. Decisions they make & actions they take before surgery can be every bit as essential as the procedure itself in ensuring a complete recovery. Getting a second opinion from an orthopedic surgeon who is equally qualified as the surgeon who did initial evaluation & diagnosis is suggested in any case. Patients should clearly discuss everything with their orthopedic surgeons prior to surgery. Patients who normally need posterior cruciate ligament surgery include the following.
- Grade I – When posterior cruciate ligament has partial tear
- Grade II – When a ligament is partially torn & is comparatively looser than in Grade I cases
- Grade III – When ligament is entirely torn & knee becomes highly unstable
- Grade IV – When PCL is impaired along with another ligament in knee
- PCL injuries in which pieces of bone have become loose & torn off
- Chronic PCL looseness especially seen in athletes
- Injuries involving one or more ligaments of the knee
Most patients who visit orthopedic surgeons are not well informed about the options as they should have been. Some questions are listed below which patients should be asking orthopedic surgeons.
- Proper Care – Patients should make sure that they have received proper equipments & which they will need when they get home from hospital. It may include crutches, knee braces, coolers or a continuous passive motion machine. Patients should get prescriptions for any of these from their orthopedic surgeons when the surgery is scheduled.
- Healthy Discussion – Patients should understand all possible risks & benefits of PCL surgery, and ask surgeons any queries that will help them better understand the surgical procedure. Patients can also talk to someone else who has undergone PCL surgery.
- Medications – Any physical trouble, such as an infection or fever, should be reported to orthopedic surgeons & patients should notify the orthopedic surgeon of any medications they are taking currently.
- Walking Practice – If possible, patients should practice walking with their crutches in case they need to use them after surgery.
- Arranging a Caregiver – Patients should arrange for someone to drive them home when they are released from hospital. Patients may be discharged the same day, or may be required to stay for one day in hospital.
When surgical reconstruction for posterior cruciate ligament is considered, graft suggestions include the following.
- How many years of experience do you have in performing posterior cruciate ligament surgery?
- Will my joint move naturally after you perform my PCL surgery?
- Where will you perform my surgery & how much time will be required?
- Will you remove my PCL during surgery?
- Is my knee joint highly unstable?
- Is the alignment of my knee joint close to normal?
- Will recovery take several months?
- Will I be able to go back to all my previous activities & sports after recovery?
- Will I be able to go to gym & lift weights? If so, how much of weight?
Posterior cruciate ligament is restored usually using a graft from either patient’s patellar tendon or from patellar tendon of a cadaver. Patellar tendon is a ligament that connects patient’s kneecap to the shinbone. This operation normally takes three to three-and-a-half hours. Following steps are involved in PCL surgery.
- Quadriceps tendon
- Patellar tendon
- Medial head of gastrocnemius
- Hamstring tendons
- Achilles tendon
- Quadriceps tendon
- Patellar tendon
- Hamstring tendons
Recovery begins the moment patients wake up in recovery room & continues at home, to regain range of motion & strength to the knee. Patients will likely feel some pain & discomfort for a few days after PCL surgery. Patients may take pain medications as the orthopedic surgeon advises. Patients should keep the knee elevated as much as possible, above heart level to minimize pain & swelling. Icing the operated knee for 15 or 30 minutes, few times a day after surgery will also help to diminish pain. Dressing on patient’s knee is commonly removed the day after PCL surgery. There may be slight drainage for few days. Bandages or sterile dressings may be used during this interval of time. In the first week after PCL surgery, most patients are inspired to lift their leg without any support while lying down on their back. These are referred to as straight leg raises. Patients are normally able to walk without any crutches by the end of second week. Once, swelling & pain related with torn posterior cruciate ligament has reduced, patients can practice physical therapy aimed at strengthening thigh muscles & restoring knee's range of movement. Depending upon the patient’s improvement, doctors will decide when it is safe to return back to sports. Patients should be able to perform following set of activities.
- Anesthesia – General anesthesia is usually used for PCL surgery, though in some of the cases an epidural or spinal anesthetic is involved. Surgeons will administer anesthesia once the patient is ready for surgery inside the operating room.
- Incisions – Orthopedic surgeons make incisions between 2 – 3 inches long in size & a graft called an Autograft is extracted from middle region of the patellar tendon, which is a ligament that hooks kneecap to bone of lower leg. A small piece of bone remains joined to tendon on either side & is detached with graft. When a tendon from a cadaver (allograft) is used, there will be no requirement to make incisions for removing a graft from the leg. Orthopedic surgeons may need to make a tiny incision in back of the patient’s knee to assist placement of PCL graft.
- Arthroscope – Orthopedic surgeons use an arthroscope to inspect inside the knee & several small instruments to help with reconstruction of PCL. Graft is then joined to femur & tibia.
- Placing of Screws – Screws are put in proper position to hold the tendon until it becomes assuredly attached to the bone. There is no need to remove these screws any time later.
- Closing Incisions – At last, incisions are sewn up & the patient is taken to the recovery room. Some patients remain in hospital for one more day after PCL surgery.
Everyone's speed of recovery is different & depends upon individual determination, but recovery following PCL surgery generally takes between four to six months of time.
Severe complications are rare with PCL surgery. However, an infection can occur & this possibly could damage the result of surgery. The following list gives an idea about possible risks & complications of PCL surgery.
- Sprint & jog without limping
- Bend & extend the knee without pain
- Sense as if the injured knee is as strong as the other knee
- Stop & cut while running without discomfort
- Experience no swelling
Posterior cruciate ligament surgery & procedure increases range of movement while minimizing pain in those patients who are suffering from various forms of work or sports injuries. Goal of posterior cruciate ligament surgery is to improve quality of life & mobility of patients. Patients experiencing severe pain from posterior cruciate ligament injury will benefit from reduced pain, increased strength, mobility & stability of the knee joint following PCL surgery.
- Deep vein thrombosis
- Persistent pain & stiffness
- Severe infection
- Graft failure
- Anesthetic complications
- Inflammation & swelling
- Anterior knee complications
Medical Tourism in India for Best Posterior Cruciate Ligament Surgery
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