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PCL Injury

Posterior Cruciate Ligament (PCL) Injury Overview

The posterior cruciate ligament (PCL) is one of the four main ligaments of the knee responsible for keeping the knee stable. The PCL prevents the shin bone (tibia) from sliding too far backward and keeps the shin bone in position with the thigh bone (femur). The PCL is the strongest ligament in the knee; therefore, a PCL injury is rare and accounts for approximately 20 percent of ligament injuries. Dr. Brian Waterman, orthopedic knee specialist serving patients in Winston Salem, Greensboro, High Point, North Carolina specializes in treating PCL injuries, such as a PCL tear or other similar ligament injury.

A PCL injury is most often caused by a powerful force to the knee in a sports activity or other traumatic event such as a motor vehicle accident. This ligament injury can occur when a basketball player falls on the knee while in a bent position, a hockey player hits the goalpost while sliding on the ice or when an individual hits the dashboard of a car in an automobile accident while in a bent position.

Symptoms of a PCL Injury

A PCL injury is a serious ligament injury and can often go undiagnosed unless a complete PCL tear occurs. Patients will experience knee pain, swelling and a decreased range of motion in most cases. Swelling tends to occur very soon after the injury because of the vascular nature of the ligament. Patients may also experience knee tenderness and instability. Instability is not as common as in an ACL injury, but may occur from a severe PCL tear.

Diagnosis of a PCL Injury

During a patient’s initial consultation, Dr. Waterman will perform a thorough physical examination. He will perform various tests, including the posterior drawer test and reverse Lachman’s test, to test range of motion, pain level and overall mobility. Dr. Waterman may also perform X-rays, kneeling posterior knee stress X-rays and an MRI to determine the ligament injury extent and confirm the diagnosis.

Injuries to the ligament range from a Grade 1 to Grade 3:

  • Grade 1: A small partial tear
  • Grade 2: A near complete tear
  • Grade 3: A complete tear with other ligament injury

Treatment of a PCL Injury

An isolated PCL injury is commonly treated by a non-surgical approach since most of the injuries involve a partial PCL tear. For more severe tears of the PCL, or those involving other ligaments, a surgical approach is often recommended by Dr. Waterman and his orthopedic team.


Most minor PCL injuries can be treated with rest, ice, compression and elevation (RICE method). A physical therapy recovery program may be recommended to strengthen the quadriceps muscle and increase the affected knee’s range of motion. A brace and crutches may also be recommended to restrict the knee’s movement and allow ample time for the ligament injury to heal.


A complete PCL tear is often treated by Dr. Waterman through a surgical approach. Higher level athletes often undergo knee surgery to return the knee to full function and stability. If surgery is recommended, Dr. Waterman will perform a PCL reconstruction in most cases to improve knee function and decrease the patient’s chances of developing knee arthritis in the future.

A PCL reconstruction surgery uses an allograft (donor tissue) to reconstruct the ligament and restore knee stability. This procedure is commonly performed arthroscopically by minimal incisions for a quicker return to everyday activities with less pain.

At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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