The posterior cruciate ligament (PCL) sits deep in the center of the knee and keeps the shinbone from sliding backward. It is injured less commonly than the ACL, classically from a 'dashboard' impact to the front of the bent knee or a fall onto a bent knee.
Unlike the ACL, many isolated PCL injuries do well without surgery, because the ligament has some capacity to heal and the knee can be stable enough for daily life and many sports with good quadriceps strength. The grade of the tear and whether other ligaments are torn guide the decision.
Symptoms
Common findings include:
- Knee pain and swelling after a dashboard-type impact or a fall onto a bent knee
- A vague sense of instability, often less dramatic than an ACL tear
- Difficulty with stairs and slopes
- Pain at the back of the knee
How it is diagnosed
The exam tests for backward sag and shift of the shinbone, and MRI confirms the grade of the PCL tear and whether other ligaments, especially the posterolateral corner, are involved. Identifying combined injuries is important, because they change the plan.
Dr. Lee treats most isolated, lower-grade PCL injuries without surgery, with a structured rehabilitation program focused heavily on quadriceps strength, sometimes with a specialized brace. Many patients return to full activity this way.
Reconstruction is considered for high-grade tears, for combined ligament injuries, and for patients with persistent instability despite rehabilitation. Because PCL injuries often travel with posterolateral corner injuries, a complete assessment is what determines whether surgery is needed and what it should include.
Non-surgical treatment
Isolated, lower-grade PCL injuries are treated with a quadriceps-focused rehabilitation program, sometimes with a dynamic PCL brace. Many patients regain a stable, functional knee without surgery.
Surgical treatment
High-grade tears, combined ligament injuries, and knees with persistent instability are treated with PCL reconstruction, addressing any associated ligament injury at the same time. Restoring stability protects the cartilage and the rest of the knee.
Recovery timeline
Recovery depends on the grade and treatment:
- Non-surgical, weeks 0 to 12Bracing as directed and a quadriceps-focused rehabilitation program, with a graded return to activity.
- After reconstruction, weeks 0 to 6Brace protecting the graft, with guided motion and protected weight-bearing.
- Months 3 to 9Progressive strengthening and a graded return to sport.
What patients commonly misunderstand
How it differs from the ACL:
- A PCL tear is not an automatic surgery. Unlike the ACL, many isolated PCL injuries do well without reconstruction, especially with strong quadriceps. The decision depends on the grade and whether other ligaments are torn.
- Check the posterolateral corner. PCL injuries often accompany posterolateral corner injuries. Missing the corner is a common reason a PCL knee stays unstable, so a complete exam matters.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.