Howard J. Levy, M.D.: Nonsurgical: Posterior Cruciate Ligament Tear
Injuries and Conditions : Knee : Posterior Cruciate Ligament Tear : Treatment : Non-Surgical : Conservative Treatment of PCL
 
Overview
A damaged PCL will not necessarily require surgery for a full recovery. Differences in the severity and in the type of injury will dictate the treatment decisions, as will the degree of athletic activity that the patient wishes to pursue after treatment. PCL injuries may range from minor sprains to complete tears of the ligament, and some patients, even with quite severe injuries, may choose to not undergo surgery. However, a completely torn PCL cannot rebuild itself, surgery to reattach or reconstruct the ligament is usually recommended. Less active patients with a complete tear may not always require this procedure.
Rehabilitation Program
  • Physical therapy is designed to restore strength and improve stability of the knee through motion and strength exercises, stretching and muscle stimulation.
  • The initial therapy goal is to re-establish a full range of motion in the knee.
  • Ongoing therapy rehabilitates the quadriceps and hanstrings, and the surrounding muscles to add strength and control to the joint.
  • Therapists may recommend changes in activity and specialized knee braces to support the knee during movement or when the patient is engaged in athletic activity.

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    Medication and Medical Products
    Knee: Compression Sleeves Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.


    • Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella

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    Knee Braces Knee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.

    Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.

    Knee braces can be used to treat:

  • Pre-operative ACL/PCL ruptures or injuries
  • Non-surgical ACL/PCL injuries
  • General knee instability
  • Pre/post joint replacement with ligament instability
  • Grade II or III ligament sprains.



    • Long-Term Expectations for Recovery
  • Patients with more minor injuries can expect to fully recover after more than a month of physical therapy.
  • Patients suffering severe injuries that have resulted in the partial tearing of the PCL will require a much longer time to rehabilitate, although a full recovery is still possible with intensive physical therapy. These injuries typically heal in three or more months.
  • A patient that is considered to be fully recovered may participate in athletic activities at their pre-injury level.
  • Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent re-injury to the knee. In some cases this will mean completely avoiding certain activities that place additional stress on the knee.
  • Recovery is more dependent on the condition of the joint and how the internal structures have been repaired and healed, and less dependent on the number of days, weeks or months since the injury occurred.

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    Possible Complications and Risks
  • Re-injury to the joint is possible if physical therapy becomes too strenuous for the condition of the knee.
  • For injuries with a severely sprained or damaged PCL, physical therapy may not sufficiently recondition the ligament for vigorous athletic activities.
  • For injuries with a completely torn PCL, patients that continue to have the leg give way or fail to support their weight may damage other structures in the knee with each episode in which the knee collapses.

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