Physical Therapy in Venice for Knee

Welcome to FYZICAL Venice's patient resource about Posterior Cruciate Ligament Injuries.

The posterior cruciate ligament (PCL) is one of the less commonly injured ligaments of the knee. Understanding this injury and developing new treatments for it have lagged behind the other cruciate ligament in the knee, the anterior cruciate ligament (ACL), probably because there are far fewer PCL injuries than ACL injuries.

This article will help you understand:

• where the PCL is located
• how a PCL injury causes problems
• how doctors treat the condition

Where is the PCL, and what does it do?

Ligaments are tough bands of tissue that connect the ends of bones together. The PCL is located near the back of the knee joint. It attaches to the back of the femur (thighbone) and the back of the tibia (shinbone) behind the ACL.

PCL

The PCL is the primary stabilizer of the knee and the main controller of how far backward the tibia moves under the femur. This motion is called posterior translation of the tibia. If the tibia moves too far back, the PCL can rupture.

Ruptured PCL

More recent research has shown us that the PCL also prevents medial-lateral (side-to-side) and rotatory movements. This confirms the suspicion that the PCL’s effect on knee joint function is more complex than previously thought.

The PCL is made of two thick bands of tissue bundled together. One part of the ligament tightens when the knee is bent; the other part tightens as the knee straightens. This is why the PCL is sometimes injured along with the ACL when the knee is forced to straighten too far, or hyperextend.

Both bundles of the PCL not only change length with knee flexion and extension, but they also change their orientation (direction of the fibers) from front-to-back and side-to-side. This function allows the ligament to keep the tibia from sliding too far back or slipping from side-to-side.

Related Document: FYZICAL Venice's Guide to Knee Anatomy

How do PCL injuries occur?

PCL injuries can occur with low-energy and high-energy injuries. The most common way for the PCL alone to be injured is from a direct blow to the front of the knee while the knee is bent. Since the PCL controls how far backward the tibia moves in relation to the femur, if the tibia moves too far, the PCL can rupture.

Sometimes the PCL is injured during an automobile accident. This can happen if a person slides forward during a sudden stop or impact and the knee hits the dashboard just below the kneecap. In this situation, the tibia is forced backward under the femur, injuring the PCL. The same problem can happen if a person falls on a bent knee. Again, the tibia may be forced backward, stressing and possibly tearing the PCL.

Other parts of the knee may be injured when the knee is violently hyperextended, but other ligaments are usually injured or torn before the PCL. This type of injury can happen when the knee is struck from the front when the foot is planted on the ground.

What does an injured PCL feel like?

The symptoms following a tear of the PCL can vary. The PCL is not actually enclosed inside the knee joint like the ACL. So unlike an ACL tear, which swells the joint with blood, PCL injuries don't make the knee swell as much. Most patients with a PCL injury sense a feeling of stiffness and some swelling. Some patients may also have a feeling of insecurity and giving way of the knee, especially when trying to change direction on the knee. The knee may feel like it wants to slip.

The pain and moderate swelling from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable. The symptom of instability and the inability to trust the knee for support are what requires treatment. Also important in the decision about treatment is the growing realization by orthopedic surgeons that long-term instability leads to early arthritis of the knee.

When you visit FYZICAL Venice, our Physical Therapist will take your history and do a physical exam. The history and physical examination are probably the most important tools in diagnosing a ruptured or deficient PCL. During the physical examination, we will perform special stress tests on the knee. Three of the most commonly used tests are the posterior Lachman test, the posterior sag test, and the posterior drawer test. The posterior drawer test is a very sensitive and specific test for PCL injuries. Our Physical Therapistwill place your knee and leg in various positions and then apply a load or force to the joint. Any excess motion or unexpected movement of the tibia relative to the femur may be a sign of ligament damage and insufficiency.

We will also do tests to see if other knee ligaments or joint cartilage have been injured. Damage to the PCL along with damage to the posterolateral corner (PLC) of the joint cartilage often leads to rotatory instability. This means the tibia slides back on the femur and twists or rotates at the same time. Rotatory instability can affect your ability to walk properly.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at FYZICAL Venice have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

FYZICAL Venice provides Physical Therapist services in Venice.

Non-surgical Rehabilitation

At FYZICAL Venice, initial treatment for a PCL injury focuses on decreasing pain and swelling in the knee. Rest and mild pain medications, such as acetaminophen, can help decrease these symptoms. Our therapist may advise use of a long-leg brace and crutches at first to limit pain. Most patients are given the okay to put a normal amount of weight down while walking.

Less severe PCL tears are usually treated with a progressive rehabilitation program. Patients intending to return to high-demand activities may require a functional knee brace before returning to these activities. These braces are designed to replace knee stability when the PCL doesn't function properly. They help keep the knee from giving way during moderate activity, but they can give a false sense of security and won't always protect the knee during sports that require heavy cutting, jumping, or pivoting. These braces are not the type you can buy at the drugstore. Most Physical Therapists will recommend wearing a brace for at least one year after a reconstruction, so even if you decide to have surgery, a brace is probably a good investment.

When you visit, FYZICAL Venice, our Physical Therapist will treat your swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation.

We will use exercises to help you regain normal movement of joints and muscles. Range-of-motion exercises should be started right away with the goal of helping you swiftly regain full movement in your knee. These include the use of a stationary bike, gentle stretching, and careful pressure applied to the knee by the Physical Therapist.

Our therapist will also give you exercises to do for improving the strength of the quadriceps muscles on the front of the thigh. As your symptoms ease and strength improves, we will guide you in specialized exercises to improve knee stability.

Nonsurgical treatment of an injured PCL will typically last six to eight weeks. You will be able to return to your sport activities when your quadriceps muscles are back to near their normal strength, your knee stops swelling intermittently, and you no longer have problems with the knee giving way.

Post-surgical Rehabilitation

You may use a continuous passive motion (CPM) machine immediately after your operation to help the knee begin to move and to alleviate joint stiffness. The machine straps to the leg and continuously bends and straightens the joint. This continuous motion is thought to reduce stiffness, ease pain, and keep extra scar tissue from forming inside the joint.

Our Physical Therapist may also have you wear a protective knee brace for up to six weeks after surgery. You'll probably use crutches for two to four weeks in order to keep your knee safe and will probably be instructed to put only a limited amount of weight down while you're up and walking.

Patients usually take part in formal Physical Therapy after PCL reconstruction. The first few Physical Therapy treatments are designed to help control the pain and swelling from the surgery. Therapists will begin to focus on range of motion exercises within three weeks. They take care to avoid letting the tibia sag back under the femur, as this can put strain on the healing graft.

Strengthening exercises for the quadriceps muscle on the front of the thigh are safe to begin right away. Muscle stimulation and biofeedback, which both involve placing electrodes over the quadriceps muscle, may be needed at first to get the muscle going again and help retrain it. As the rehabilitation program evolves, our Physical Therapist will choose more challenging exercises to safely advance the knee's strength and function.

When you get full knee movement, your knee isn't swelling, and your strength is improving, you'll be able to gradually get back to your work and sport activities. Our Physical Therapist may prescribe the use of a functional brace for athletes who intend to return quickly to their sport.

Ideally, you'll be able to resume your previous lifestyle activities. However, we usually advise athletes to wait at least six months before returning to their sport. And most patients are encouraged to modify their activity choices.

Overall, although recovery time varies, you will probably be involved in a progressive rehabilitation program for four to six months after surgery to ensure the best result from your PCL reconstruction. In the first six weeks following surgery, you can expect to see the Physical Therapist about two to three times a week. If your surgery and rehabilitation go as planned, it is possible that you may only need to do a home program and see your therapist every few weeks over the four to six month period.

FYZICAL Venice provides services for Physical Therapy in Venice.