Treatment

PCL Reconstruction

Learn all about PCL reconstructions and surgery recovery timeline.

How is it repaired?

A PCL reconstruction is a surgical procedure used to reconstruct a torn PCL. Repairing a torn PCL by surgically attaching the torn ends back together often leads to poor outcomes including persistent knee instability and increased risk of re-tearing. Instead, a torn PCL is traditionally fixed with a PCL reconstruction where a tendon graft is used to reconstruct a new PCL. A PCL reconstruction is performed through a minimally invasive surgical procedure called a knee arthroscopy.

Graft Decision

The tendon graft used to reconstruct your torn PCL can either be obtained from your own body or from a donor. Because the PCL is a thick ligament, tendon grafts for PCL reconstruction are more commonly obtained as allografts from a donor due to difficulty obtaining a large enough graft from your own tendons without significantly damaging the graft sites.

Autograft 

A PCL autograft is a grafted portion of a tendon that is removed from one area of your body and used to reconstruct the torn PCL in your knee. The tendon material used to create a new PCL is most commonly removed from one of the tendons of your hamstrings muscles located at the back of your thigh above your knee, or from the patellar tendon that connects your patella (kneecap) to the top of your tibia (shin bone).

Because an autograft is from your own body and has the same makeup of cells, there is a decreased risk of graft laxity due to improved healing rates. Due to graft removal from another part of the body, however, increased pain, muscle weakness, and rehabilitation time can occur.

Allograft

A PCL allograft is a grafted portion of a tendon that is obtained from a cadaver and used to reconstruct the torn PCL in your knee. The tendon material used to create a new PCL is most commonly removed from the hamstrings tendons, patellar tendon, Achilles tendon, or tendons from the tibialis anterior or tibialis posterior muscles of the lower leg.

Allografts result in less surgery to the body and may cause decreased pain. Because PCL reconstruction requires a large tendon graft, allografts are most commonly used to avoid large scale tendon damage to potential graft sites.

Single Bundle vs Double Bundle

While the PCL is classified as a single ligament, the structure of the PCL is actually composed of two bundles of fibers fused together, consisting of a larger anterolateral bundle and smaller posteromedial bundle.

With a single bundle PCL reconstruction, a tendon graft is used to reconstruct only the anterolateral bundle of the PCL. With a double bundle PCL reconstruction, two smaller tendon grafts are used to replace each of the two bundles of the PCL individually. The double bundle technique for PCL reconstruction most closely matches the original structure of the PCL and is associated with better outcomes for recovery.

Surgery Recovery Timeline

Full recovery from a PCL reconstruction can take between 6-12 months to return to unrestricted activity. If you have a sedentary job, you can generally return to work two weeks after your surgery. Jobs that require prolonged standing, walking, or bending can require you to take off 24 weeks or more depending on your progress with rehabilitation and how physically demanding your job duties are.

You will be required to wear a specialized dynamic force PCL knee brace that will support and stabilize your knee as it heals and progressively restrict your knee range of motion the further you bend your knee. Your knee brace will be provided to you after the surgery and will initially be locked into extension, which will prevent you from being able to bend your knee. 

Throughout your rehabilitation as your knee heals, the brace will be able to be unlocked, but you will need to continue to wear your brace at all times for up to 24 weeks to protect your PCL. To further protect your reconstructed PCL, you will likely not be able to bear weight or only partially bear on your operated leg for 6 weeks following surgery. 

During this time, you will need to use crutches to walk to avoid full weight bearing on your operated leg. After 6 weeks, you will continue to use crutches as you gradually put more weight on your operated leg. A physical therapist will be able to instruct you on how to use the crutches properly and when you are ready to safely stop using them when your strength, mobility, and gait pattern improve. 

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