1. Posterior Cruciate Ligament (PCL) Tear

2. Development of PCL Tear
Injuries to the PCL are the most uncommon and also most difficult to diagnose
Motor vehicle accidents (“Dash board injury”)
Contact sport or fall injuries where an individual falls on a bent knee with foot in plantar flexion

3. Symptoms of PCL Tear
There are three grades with different symptoms and severity
Grade 1 symptoms (stretched ligament)
Mild Tenderness on the inside of the knee
No swelling need be present
Pain on Posterior Drawer stress test but no laxity
Grade 2 symptoms (partial thickness tear of the ligament)
Significant pain in the medial aspect of the knee
Moderate swelling present
Posterior Drawer stress test will indicate moderate instability
Grade 3 symptoms (full thickness tear, or complete tear)
Varied amounts of pain
Significant joint laxity on Posterior Drawer stress test
Complaints of instability (“wobbly” or “unstable” complaints)
These injuries can also include tears to the ACL

4. Symptoms of PCL Tear Knee swelling in a PCL tear appears rapidly
Within 3 hours
Difficulty walking or a slight limp
Pain with running, decelerating, or navigating stairs in any direction

5. Grades of Ligament Tears

6. Differential Diagnosis Tests
Godfrey sign
Posterior Drawer test
Ultrasound imaging
MRI imaging

7. Godfrey’s sign

8. Posterior Drawer Test

9. Recommendation
Time from injury, location, severity, and concomitant injuries will indicate need for surgery or if conservative treatment will be sufficient
Surgery indicated immediately in presence of multiple ligamentous injuries
R.I.C.E.
Immobilization and use of functional brace
As swelling subsides Rehabilitation can begin stretching and strengthening exercises as well as weight bearing
Quadriceps muscles are key to strengthen in PCL rehabilitation

10. Prognosis
Combined injuries take longer to heal due do surgical necessity, but generally the outcomes are good with conservative treatment