Posterior cruciate ligament reconstruction

What is posterior cruciate ligament repair?

The posterior cruciate ligament (PCL) is one of the two large ligaments within the knee. It controls front to back movement. The PCL can be torn or ruptured during sports activities or from a direct blow to the knee. Once broken, it may heal but is usually a longer length than normal. This can cause the knee to give way, but more usually causes pain and in the longer term, osteoarthritis or wear of the knee.

Minor or moderate lengthening of the PCL is treated by physiotherapy or muscle strengthening. A severe injury of the PCL will require reconstructive surgery.

A ligament graft is required using material taken from the front of the knee or from the hamstring tendons behind the knee, both of which are able to re-grow to a large extent.

Once fixed in the knee the graft is able to form a new ligament. This process takes up to a year but you would normally be able to return to sports activity after six months.

What does this involve?

Posterior cruciate ligament reconstruction is usually performed through keyhole surgery under general anaesthetic. You would normally be admitted on the day of the operation and have an overnight stay in hospital.

You will not be able to eat for eight hours prior to surgery although you will be able to drink small amounts of water up to four hours before.

The operation takes about one hour and your Surgeon will make some incisions in your knee to allow small specially designed instruments to be introduced. The torn ligaments are trimmed and the knee is prepared for the replacement graft. The top and bottom ends of the replacement ligament are fixed into place with special screws into holes drilled into your bones.

The incisions are closed with stitches or adhesive strips

When will I recover?

Recovery from the anaesthetic is rapid and you will be awake very soon after the operation although you may feel drowsy for an hour or two. You will be allowed to go home once you are weight bearing with the assistance of crutches, if necessary, for security.

You may shower with the waterproof dressing on and your physiotherapists will give you on how to exercise your leg before you leave and may arrange outpatient physiotherapy if needed. You will be given a cold compress or 'Cryocuff' along with instructions on how to cool your knee, which is important and aids recovery. You will be in a knee brace or sometimes a plaster cast and you will see your consultant once again two weeks after your operation to review your progress.

You may need to take four to six weeks off work and driving following the operation and rehabilitation following a PCL reconstruction is extensive. You will require physiotherapy once a week for two to three months and less frequently up to nine months.

What risks should I know about?

Posterior cruciate ligament reconstruction is commonly performed and generally safe but there are some potential complications you should be aware of. These only affect less than 4% of patients.

  • Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates at 1-2%.
  • Blood clots are possible but again are in the 1-4% category and have well established treatments including aspirin.
  • A small patch of numb skin can be present on the outer part of the knee near the kneecap, this will improve over time.

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