The posterior cruciate ligament is located in the back of the knee. It is
one of several ligaments that connect the femur (thighbone) to the tibia
(shinbone). The posterior cruciate ligament keeps the tibia from moving
backwards too far.
An injury to the posterior cruciate ligament requires a powerful force. A
common cause of injury is a bent knee hitting a dashboard in a car accident or
a football player falling on a knee that is bent.
Two bones meet to form your knee joint: your thighbone (femur) and shinbone
(tibia). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary
ligaments in your knee. They act like strong ropes to hold the bones together
and keep your knee stable.
knee anatomy, front view
Collateral ligaments. These are found on the sides of
your knee. The medial collateral ligament is on the inside and the lateral
collateral ligament is on the outside. They control the sideways motion of your
knee and brace it against unusual movement.
Cruciate ligaments. These are found inside your knee
joint. They cross each other to form an “X” with the anterior cruciate ligament
in front and the posterior cruciate ligament in back. The cruciate ligaments
control the back and forth motion of your knee.
The posterior cruciate ligament keeps the shinbone from moving backwards too
far. It is stronger than the anterior cruciate ligament and is injured less
often. The posterior cruciate ligament has two parts that blend into one
structure that is about the size of a person’s little finger.
Injuries to the posterior cruciate ligament are not as common as other knee
ligament injuries. In fact, they are often subtle and more difficult to
evaluate than other ligament injuries in the knee.
Many times a posterior cruciate ligament injury occurs along with injuries
to other structures in the knee such as cartilage, other ligaments, and bone.
A complete tear of the posterior
cruciate ligament, back view.
Injured ligaments are considered “sprains” and are graded on a severity
Grade 1 Sprains. The ligament is mildly damaged in a
Grade 1 Sprain. It has been slightly stretched, but is still able to help keep
the knee joint stable.
Grade 2 Sprains. A Grade 2 Sprain stretches the
ligament to the point where it becomes loose. This is often referred to as a
partial tear of the ligament.
Grade 3 Sprains. This type of sprain is most commonly
referred to as a complete tear of the ligament. The ligament has been split into
two pieces, and the knee joint is unstable.
Posterior cruciate ligament tears tend to be partial tears with the potential
to heal on their own. People who have injured just their posterior cruciate
ligaments are usually able to return to sports without knee stability problems.
An injury to the posterior cruciate ligament can happen many ways. It
typically requires a powerful force.
blow to the front of the knee (such as a bent knee hitting a dashboard in
a car crash, or a fall onto a bent knee in sports)
stretching the ligament (such as in a twisting or hyperextension injury)
The typical symptoms of a posterior cruciate ligament injury are:
swelling that occurs steadily and quickly after the injury
that makes the knee stiff and may cause a limp
feels unstable, like it may “give out”
During your first visit, doctor will talk to you about your symptoms and
During the physical examination, your doctor will check all the structures
of your injured knee, and compare them to your non-injured knee. Your injured
knee may appear to sag backwards when bent. It might slide backwards too far,
particularly when it is bent beyond a 90° angle. Other tests which may help
your doctor confirm your diagnosis include X-rays and magnetic resonance
imaging (MRI). It is possible, however, for these pictures to appear normal,
especially if the injury occurred more than 3 months before the tests.
X-rays. Although they will not show any injury to your
posterior cruciate ligament, X-rays can show whether the ligament tore off a
piece of bone when it was injured. This is called an avulsion fracture.
MRI. This study creates better images of soft tissues
like the posterior cruciate ligament.
Sagittal and coronal T2-weitghted magnetic resonance images of the knee,
showing upward displacement of the PCL insertion at the tibia (a) and the
displaced fragment of the lateral tibial condyle (b and c).
If you have injured just your posterior cruciate ligament, your injury may
heal quite well without surgery Your doctor may recommend simple, nonsurgical
options. RICE. When you are first injured, the RICE method – rest,
ice, gentle compression and elevation — can help speed your recovery.
Immobilization. Your doctor may recommend a brace to
prevent your knee from moving. To further protect your knee, you may be given
crutches to keep you from putting weight on your leg.
Physical therapy. As the swelling goes down, a careful
rehabilitation program is started. Specific exercises will restore function to
your knee and strengthen the leg muscles that support it. Strengthening the
muscles in the front of your thigh (quadriceps) has been shown to be a key
factor in a successful recovery.
Your doctor may recommend surgery if you have combined injuries. For
example, if you have dislocated your knee and torn multiple ligaments including
the posterior cruciate ligament, surgery is almost always necessary.
Rebuilding the ligament. Because sewing the ligament
ends back together does not usually heal, a torn posterior cruciate ligament
must be rebuilt. Your doctor will replace your torn ligament with a tissue
graft. This graft is taken from another part of your body, or from another
human donor (cadaver). It can take several months for the graft to heal into
Procedure. Surgery to rebuild a posterior cruciate
ligament is done with an arthroscope using small incisions. Arthroscopic
surgery is less invasive. The benefits of less invasive techniques include less
pain from surgery, less time spent in the hospital, and quicker recovery times.
Surgical procedures to repair posterior cruciate ligaments continue to
improve. More advanced techniques help patients resume a wider range of
activities after rehabilitation.
Whether your treatment involves surgery or not, rehabilitation plays a vital
role in getting you back to your daily activities. A physical therapy program
will help you regain knee strength and motion. If you had surgery, physical
therapy will begin 1 to 4 weeks after your procedure.
How long it takes you to recover from a posterior cruciate ligament injury
will depend on the severity of your injury. Combined injuries often have a slow
recovery, but most patients do well over time.
If your injury requires surgery, it may be several weeks before you return
to a desk job – perhaps months if your job requires a lot of activity. Full
recovery typically requires 6 to 12 months.
Although it is a slow process, your commitment
to therapy is the most important factor in returning to all the activities you