Posterior Cruciate Ligament (PCL) Reconstruction

The posterior cruciate ligament (PCL) is one of the four major ligaments found in the knee. It runs diagonally through the middle of the knee to connect the back of the femur to the front of the tibia. The PCL works together with the ACL to control any back-and-forth motion of the knee. The PCL is larger and stronger than the ACL, which is why it is injured less frequently. Often, an injury to the PCL occurs along with injuries to other structures in the knee like the cartilage, ligaments, and bone.


Not every PCL tear requires surgery to heal. Whether surgical treatment is necessary will depend on the patient’s age, activity level, symptoms, and other factors. For example, this procedure will be highly recommended for young athletes as the stability of the knees is vital for returning to sports. A PCL reconstruction is a surgical procedure to rebuild a patient’s torn posterior cruciate ligament. It can also help minimize the chance of developing arthritis of the knee when the patient gets older.

Causes of PCL Tears

PCL tears often occur due to severe trauma to the knee joint like automobile accidents or falling on the knee, particularly while the knee is flexed or bent. Hits or falls while the knee is bent during sports like football or soccer are often the cause of PCL injuries. Hyperextension of the knee during athletic movements like jumping is another possible cause of a PCL tear.

Symptoms of a PCL Tear

The severity of a patient’s symptoms after a PCL tear depends on the extent of the injury. Some of the common symptoms that occur are:

  • Tenderness in the knee, especially at the back of the knee
  • Instability of the knee joint; feeling like it is going to give way
  • Pain around the knee
  • Swelling in the knee
  • Knee stiffness
  • Difficulty bearing weight on the knee like while walking

The Procedure

PCL reconstruction is generally performed using a minimally invasive procedure called arthroscopy. 

The surgeon will begin by making small incisions around the knee joint. Through one of the incisions, an arthroscope is inserted so the surgeon can inspect the condition of the knee. Small surgical instruments will be inserted through other incisions to shave away the damaged ligament and remove it. It will also be prepared for the autograft, which is often taken from the patellar ligament. 

Next, a pin is inserted diagonally from the tibia to the femur, which will serve as a guide to recreate the PCL. With the pin as a guide, tunnels will be drilled into the femur and tibia to properly position the graft. 

Then, the autograft will be attached to the guide pin and pulled through the holes made in the femur and tibia. Once it is in place, surgical screws will be inserted to hold the autograft in place.

Finally, all of the tools will be removed from the knee before the incisions are closed using sutures or surgical staples.

After the Procedure

Most PCL reconstruction patients will be able to return home on the same day as the surgery. Bearing weight on the knee is avoided until about 8 weeks after the surgery, when physical therapy also begins. Physical therapy is essential for recovery after a PCL reconstruction. This will help ensure the long-term success of the reconstruction and limit the chance of reinjury or further damage to the knee joint. Until the joint has regained its normal strength, crutches will likely be necessary.

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