PCL Reconstruction

Posterior Stability, Rebuilt with Precision

The posterior cruciate ligament (PCL) is the knee's strongest ligament, preventing the shin bone from sliding backward under the thigh bone. PCL injuries are less common than ACL injuries and typically result from a direct blow to the front of the shin - such as a dashboard injury in a car accident, or a heavy fall onto a bent knee during contact sport.

Dr Adam Farrier is a consultant knee surgeon offering PCL reconstruction for patients in Carlisle and across Cumbria, including West Cumberland (Whitehaven), and in Newcastle upon Tyne and the North East.

Is PCL Reconstruction Right for You?

Many PCL injuries, particularly partial tears, can be managed successfully without surgery through bracing and targeted rehabilitation. Reconstruction is generally reserved for complete tears, injuries combined with damage to other ligaments, or cases where significant instability persists despite a thorough period of bracing and course of physiotherapy. A careful assessment of the grade of injury and your functional demands guides this decision.

The Procedure

PCL reconstruction is performed arthroscopically, using a tendon graft to recreate the ligament and restore posterior stability to the knee. Because the PCL sits deeper within the knee than the ACL, the surgery is technically demanding and is often combined with treatment of any associated ligament injuries in more complex, multi-ligament cases.

The Benefits of Reconstruction

• Restored Posterior Stability: Reconstruction addresses the backward sliding of the shin bone that causes a feeling of instability, particularly on stairs or slopes.

• Protecting Other Structures: Long-standing PCL instability can place abnormal load on the cartilage of the knee; addressing it helps protect these surfaces over time.

• Treating Multi-Ligament Injuries: Where the PCL is injured alongside other ligaments, reconstruction allows a coordinated approach to restoring overall knee stability.

• Return to Function: Most patients see significant improvement in stability and confidence in the knee during daily activities and sport-specific movements.

Important Considerations & Risks

• Slower Recovery than ACL Surgery: PCL rehabilitation is typically more cautious and gradual than ACL rehabilitation, to protect the healing graft from posterior forces. A protracted period in a PCL brace can be expected (usually 3 months).

• Residual Laxity: Some mild residual looseness can persist even after successful reconstruction, particularly in high-grade injuries.

• Stiffness: The knee can be prone to stiffness after PCL surgery, making early, guided physiotherapy particularly important.

Frequently Asked Questions

Can a PCL injury be treated without surgery?

Yes, many isolated and partial PCL injuries respond well to a structured non-surgical with bracing and a rehabilitation programme focused on quadriceps strengthening. This will be discussed with you as a genuine first option where appropriate. 

How is a PCL injury diagnosed?

Diagnosis is based on clinical examination alongside MRI, which helps grade the severity of the tear and identify any associated ligament or cartilage injuries.

What does recovery involve?

Recovery involves a carefully staged rehabilitation programme, often using a specific brace in the early period to protect the graft, with a gradual progression of strength and range of motion under physiotherapy guidance.

Dr Farrier's Note

"PCL injuries are often more complex than they first appear, and getting the diagnosis and treatment plan right from the outset makes a real difference to the long-term outcome. I take a thorough, individualised approach to every PCL injury I see."