Posterior cruciate ligament (PCL) tear
Understanding this condition
The posterior cruciate ligament (PCL) is the counterpart of the ACL: it prevents the tibia from sliding backward under the femur. It is anatomically thicker and stronger, making it less frequently injured.
Its rupture most often occurs during a direct blow to the front of the tibia with the knee bent: a road traffic accident (dashboard injury), a forward fall in skiing or on a motorbike, or a contact sports collision.
Symptoms
In the acute phase: pain, swelling, difficulty bending or bearing weight on the leg. The diagnosis may be missed as the signs are sometimes less dramatic than for an ACL tear.
Later, the instability is different — less a "knee giving way" and more a "leg giving out", especially on descents or with prolonged loading. Anterior knee pain (patella) may develop.
How can it progress?
Like the ACL, a torn PCL does not heal spontaneously. However, an isolated PCL tear is better tolerated than an ACL tear, and many patients recover satisfactory function with appropriate rehabilitation.
On the other hand, with associated multi-ligament injuries (PCL + LCL or other ligaments), instability is severe and progression to osteoarthritis is faster.
Treatment options
First line: non-surgical treatment — specific physiotherapy to strengthen the quadriceps (which partially compensates for the PCL), bracing in certain cases. This is sufficient for the majority of isolated tears.
Surgical reconstruction is reserved for persistent instability, multi-ligament injuries, or highly active patients. A specialist consultation clarifies the indication.