In isolation, PCL injury often causes little long-term instability. However, it may lead to medial or PF joint pain at a later date. It is more troublesome in soccer players owing to difficulty in deceleration.
Acute isolated PCL injury is commonly missed as it may present with very little pain in the knee without haemarthrosis. There may be only bruising at the popliteal fossa. Chronic PCL injury on the other hand may present with pain in the medial compartment or anterior knee pain.
Figure 17.13 (a, b) Sagittal and coronal T2 MRI scan revealing a ruptured PCL
It is acceptable to treat an acute, isolated PCL injury conservatively. The knee is kept in extension in a brace with calf support (posterior tibial support, PTS brace) until the pain subsides (4-6 weeks) with quadriceps rehabilitation. Start early passive motion only in the prone position to maintain anterior tibia translation.
Outcome is poor after meniscectomy, or with patellar chondrosis, gross laxity and weak quadriceps. If associated with posterolateral or posteromedial injuries, knee stability is dramatically reduced.
Arthroscopic reconstruction, although technically demanding, is safe and commonly performed nowadays. Single bundle and double bundle PCL reconstruction can be performed. Double-bundle reconstruction is technically more demanding. Although both techniques resulted in similar patient satisfaction in a level II RCT as measured by outcome assessment, the double bundle procedure significantly improved knee stability.