• Posterior Cruciate Ligament (PCL) Repair

    Definition

    Posterior cruciate ligament (PCL) surgery is the repair of a ligament in the knee. When possible, the torn ligament fibers are reattached to each other. The addition of tendon or other tissue may be needed to reconstruct severely damaged ligaments.
    Posterior Cruciate Ligament
    si55550644 97870 1 Posterior Cruciate Ligament
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    Reasons for Procedure

    The PCL is one of the ligaments that connect the lower leg bone to the thigh bone. It helps to stabilize the knee during movement. PCL surgery is done to repair or replace the ligament after it is torn.
    PCL surgery may be considered if:
    • The PCL is disconnected from the bone (avulsion)
    • The injury affects:
      • The ability to move around or take part in activities (especially in athletes)
      • How well the knee moves
    • The injury affects more than one ligament in the knee
    • Other treatment methods fail

    Possible Complications

    Potential problems are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Excess bleeding
    • Infection
    • Blood clots
    • Knee instability
    • Continued pain, numbness, or stiffness in the knee
    • More surgery in the future if the treatment fails
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
    • Smoking
    • Drinking
    • Chronic diseases, such as diabetes or obesity

    What to Expect

    Prior to Procedure

    The following will be done before the procedure:
    • Physical exam
    • Blood tests
    • Imaging tests, such as an x-ray or MRI scan
    You will need to:
    • Arrange for a ride home after the procedure
    • Talk to your doctor about any medications, herbs, or supplements you are taking
    • Ask your doctor if you will any assisted devices (cane or crutches) at home during your recovery
    You may need to stop taking some medications up to one week before the surgery. Talk to your doctor about any medications that may need to be stopped.
    Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

    Anesthesia

    The type of anesthesia will depend on your medical history and extent of your injury. Options may include:
    • Spinal anesthesia—You will be awake, but have no feeling in your leg. A sedative may be used to ease anxiety and help you relax.
    • General anesthesia—You will be asleep through the procedure.

    Description of Procedure

    The procedure is most often done with a minimally invasive procedure. Small incisions are made around the knee. Special tools will create paths in the incisions for surgical tools to pass.
    Repair
    If enough of the ligament is intact, the surgeon may simply secure the damaged PCL back onto the bone. Tears in the ligament itself will be repaired with sutures. The ligament may also be secured to the bone with sutures.
    Reconstruction
    Reconstruction involves the use of tendon tissue from another part of the body or from a donor cadaver. The remains of the damaged ligament are cleaned away from the knee joint. Small incisions are made in the surface of the thighbone and shinbone inside the knee. The donated tendon is threaded through these incisions and secured with screws or staples. Over time the bone will grow over the tendon to form a tight connection.
    Once the graft is securely in place, the doctor will test the knee’s range of motion.
    When either procedure is done, the skin will be closed with stitches. Bandages will be placed on the knee.

    Immediately After Procedure

    Breathing, blood pressure, and vital signs will be monitored in a recovery room after the procedure.

    How Long Will It Take?

    Up to 2 hours depending on what needs to be done.

    How Much Will It Hurt?

    Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

    Post-procedure Care

    At the Care Center
    While at the care center, the staff will:
    • Offer pain medications to keep you comfortable
    • Place ice packs on your knee to reduce swelling and pain
    • Teach you how to use crutches
    • Teach you light exercises to do at home
    During your stay, the care staff will take steps to reduce your chance of infection such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chances of infection such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incisions
    At Home
    Recovery will focus on pain relief and rehabilitation. A knee immobilizer and crutches will be used during early recovery to keep you mobile but decrease stress on the knee. You can gradually return to regular activity as recommended by your doctor.
    Home exercise or physical therapy will be needed to maintain strength and mobility in the leg.
    Complete recovery can take 6-9 months.
    Follow your doctor's instructions.

    Call Your Doctor

    Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any yellowish discharge from the incision site
    • Swelling, pain, or heat in the calves, which may indicate a blood clot
    • Pain that can’t be controlled with medications you’ve been given
    • Numbness in the knee area
    • Persistent nausea or vomiting
    • New or worsening symptoms
    If you think you have an emergency, call for emergency medical services right away.

    RESOURCES

    Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org

    Sports Med—American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/Patient/Intro

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Knee ligament repair. John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/orthopaedic/knee%5Fligament%5Frepair%5F92,P07675. Accessed February 11, 2016.

    Rosenthal MD, Rainey CE, et al. Evaluation and management of posterior cruciate ligament injuries. Phys Ther Sport. 2012;13(4):196-208.

    Revision Information

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