Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Posterior Cruciate Ligament Tear (PCL)

SYMPTOMS

Immediate haemarthrosis and pain in the knee after a sudden hyper-flexion or hyperextension sprain or direct tackle. It is common in contact sports such as football and rugby and other high-intensity sports.

AETIOLOGY

The typical athlete suffers a hyperextension or valgus rotation sprain during sport or after a direct impact to the anterior proximal tibia while the knee is flexed (‘dashboard’ injury). The thick ligament can rupture partially
or completely. In growing athletes or after highforce trauma, the posterior tibia bone insertion can be avulsed. Note! This injury is often associated with injuries to cartilage, menisci, capsule or other ligaments.

CLINICAL FINDINGS

There is intra-articular bleeding (haemarthrosis) in most cases. If there is a capsule rupture, blood can penetrate from the joint and cause bruising. The posterior drawer test is positive if the rupture is complete. Since there are often associated injuries, examination must also include tests for collateral ligaments, menisci and cartilage.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in the knee. X-ray is valuable to rule out fractures, in particular in growing athletes or after high-impact trauma. MRI is valuable for evaluating associated injuries.

TREATMENT

An athlete with haemarthrosis and suspected PCL tear should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can verify the diagnosis and deal with associated injuries that are often missed. An athlete with a complete PCL tear can usually return to full activity in most sports without surgical reconstruction. A PCL brace is very useful. However, individual considerations must be made. These injuries should be treated by a knee specialist.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

After surgery, cycling and water exercises are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes around six months.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows a return to full sport. Recurrent pain is more common than subjective instability after a PCL injury has been thoroughly rehabilitated.

DIFFERENTIAL DIAGNOSES

ACL rupture (initial posterior sagging will give a sense of anterior translation of tibia during Lachman or anterior drawer test and mislead the examiner).

PROGNOSIS

Good-Fair. Surgery (PCL reconstruction) may be indicated in severe cases and will allow a return to professional sport within around six to nine months. Cartilage injuries and recurrent pain and effusion are common complications.

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