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Treatment of pcl Injury

Treatment of PCL Tears

PCL tears usually occur in different levels. The mild (Grade 1) level and moderate (Grade 2) level PCL tears usually heals well on its own and doesn’t need a surgery. But the severe (Grade 3) level PCL tears and multiple ligament injuries require surgical treatment. A severe PCL injury, if not treated by surgery, can lead to an early onset of arthritis of the knee joint.

The surgery is performed on complete tears of ligaments and takes place after a few weeks, to allow for the swelling to subside and allow for motion of the knee. The procedure is called Ligament Reconstruction replacing the torn PCL with a new ligament, which is usually a graft taken from the hamstring.

Although there are multiple techniques for PCL reconstruction, we do arthroscopic PCL reconstruction without opening the knee joint, which is the most advanced and effective method for treating complete PCL tears.

What are the choices for Graft selection in PCL Reconstruction?

The different types of grafts used in PCL reconstruction includes

a)Autograft – Tissues taken from patient is used as graft. The commonly used grafts are Hamstring and quadriceps tendons. Either of them can be used depending on the patient’s condition and severity of the injury.

b)Allograft – Graft from a donor is used for PCL reconstruction. Usually the Tendo-achillis with its bony attachment is used as a graft. Allografts are used when there is combines ligament injuries or when there is lack of options.

An autograft prepared by folding the Hamstrings tendons

What are the types of Techniques used in PCL Reconstruction?

While numerous techniques have been described for PCL reconstruction we can broadly categories them into

1)Inlay technique done by open or closed method where a bone plug is used to fix the tibial end of the graft. This may be associated with knee cap pain or fracture if it is taken from the patient’s knee.Alternatively Achilles tendon graft can be used when there is paucity of graft.

2)The all inside technique done using arthroscopic method. Where the graft is fixed using two sling fixation devices.

Hamstring graft used for PCL reconstruction
An graft with its bony attachment is harvested and used as an inlay graft
Autograft or allograft can be used to reconstruct the torn ACL in the all inside key hole technique.

What is the Post-Surgery Protocol PCL Reconstruction?

Like for ACL reconstruction, after surgery the knee is protected by a knee brace and the patient is made to walk without putting weight in the operated leg using zimmer frame. After 2 weeks patient is made to walk full weight bearing without he help of the zimmer frame or the crutches. After 6 weeks patient is taken through several gym activities under the supervision of the physiotherapist. By 4 to 6 months patient will be able to do all the activities including elite sports without restrictions.

Backward sagging of the shin (red arrow) is prominent in knees with PCL tear. After PCL reconstruction the sagging has improved significantly (grey arrow).
Authored By DR Raj Kanna - Orthopaedic and Knee surgeon, Chennai
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