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Everything you need to know
The PCL is very tough so it will take a powerful force to injure it. PCL injuries are far less common than ACL (anterior cruciate ligament) tears and typically happen in tandem with other knee injuries.
PCL injuries usually occur with severe knee trauma. Causes of a PCL injury include:
- Landing on a bent knee
- Landing incorrectly after a jump
- Hitting your knees on the dashboard during a car crash
- Collisions with other players when playing sport
- Dislocating your knee
- Bending your knee too far backwards
If you injure your PCL, your knee will swell, and you should feel pain round the back of the knee. You may also notice your knee’s range of motion is reduced and it could feel unstable. In mild cases, people should still be able to walk. However, in many cases people have difficulty walking and will experience severe pain. You could also find that going down an incline becomes difficult.
Some people who injure their PCL will not need surgery, and find that rest, using crutches or bracing the knee, and having physiotherapy are enough to make a full recovery – although this will take time. However, if your knee still hurts and feels unstable after a course of physiotherapy, or you have damaged other parts of your knee, surgery may be recommended.
If you have injured your knee and are worried, book an appointment with one of our specialist knee surgeons. They will assess your knee and if needed refer you for scans (such as X-ray, MRI or CT) to see the extent of injury. If surgery is recommended, your doctor will explain the risks and benefits so you can make an informed decision.
Before Surgery
Pre-surgery
Whether you have knee surgery will depend on the extent of damage to your PCL, if you have other injuries in your knee, and if your quality of life is being affected.
If your knee feels stable and you don’t notice an impact on your day-to-day life, you may decide that pain relief, wearing a knee brace, and physiotherapy are enough.
However, if your knee feels unstable, is painful, and you are not able to take part in activities you enjoy, PCL surgery could be a good option for you.
Prehab
If you decide to have surgery, you may need to wait for any swelling to go down and also see a physiotherapist for ‘prehab.’ This will aim to increase the range of motion in your knee and strengthen the surrounding muscles as this will lead to better outcomes after surgery. Exercises to strengthen your thigh muscles (quadriceps) are especially important after PCL injuries.
In the run up to surgery, you should regularly do your prehab exercises and avoid movements that could worsen your injury, including twisting and jumping.
If you would like physiotherapy help, we have an excellent therapies department at the hospital who can support you before and after surgery.
Pre-Assessment
Before your surgery, you will need to come into hospital for a pre-assessment, where we can check your fitness for surgery. This is a standard check and includes a physical exam, blood tests, heart and lung function tests as well as an MRSA test. We will also give you antibacterial soap and lotions to use in the run up to the procedure, which will help reduce your risk of contracting MRSA.
If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Surgery day
A PCL reconstruction is a day-patient surgery. This means you can be treated and go home the same day.
You should stop eating six hours before surgery. Two hours before, you should stop drinking (including water), chewing gum and sucking boiled sweets. Brush your teeth with toothpaste only on the morning of surgery.
Wear loose, comfortable clothes and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications. Your doctor will let you know if you can take any medications with a sip of water before surgery or if you should wait until after.
Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.
Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.
During Surgery
A PCL injury is usually treated with knee arthroscopy, which is a minimally invasive procedure. Most people will be treated and go home the same day.
Before the surgery starts, you will be anaesthetised. There are options, including general anaesthesia where you are unconscious and need a breathing tube to help you breathe, and spinal where anaesthetic is injected into your spine to numb the lower half of your body. With spinal, you can also be given sedation to help you relax.
An arthroscopy involves making a small incision in your knee and inserting a tiny tube with a camera and light through this. The camera sends images to a monitor allowing your surgeon to examine the interior of the knee. Tiny tools used to repair your PCL are inserted through another small incision.
Your surgeon will repair the damaged ligament and any other injury in your knee and then close the incisions using stitches.
Typically, a knee arthroscopy takes one hour.
After Surgery
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery.
Our nursing team will make regular checks to make sure your recovery is going to plan, and they will also encourage you to get up and walk as soon as possible. They will provide you with a knee brace or crutches to help you get around. Your surgeon will also visit you and let you know how surgery went. Then, once you’ve had some food and drink, you can go home.
You will need someone to collect you and stay with you overnight as anaesthetic and sedation can make you feel very tired for around 24 hours. During this time you should not drink alcohol, cook or make important decisions.
If possible, arrange for someone to help you for a couple of weeks post-surgery as well, as your knee will be bruised, swollen and quite painful for 1-2 weeks after surgery. During this time, take your prescribed painkillers, apply a cold wrap to your knee, and keep your leg elevated as much as possible. When moving around use crutches or a knee brace as you should not put too much weight on your knee at this point.
It will take approximately two weeks for your wound to heal, and you should see your doctor at this point for a post-surgery check, where any clips or non-dissolvable stitches will be removed. Dissolvable stitches should disappear on their own after around three weeks.
After 2-3 weeks, you should be able to start walking without crutches/the brace and put more weight on your knee. You should be able to return to office work at this point as well, though if you have a manual job, you may have to wait up to 3 months.
From 2 weeks onwards, you should do your physiotherapy exercises regularly as these will help improve your balance, flexibility in your knee, and increase the strength in the surrounding muscles. You should be able to start driving again after 3-4 weeks or once putting weight on your knee feels comfortable.
In the weeks following an operation, patients have a slightly higher risk of a blood clot, so will need to avoid flying. You should wait six weeks before taking a short haul flight (under six hours) and 12 weeks before taking a long-haul flight.
Many people, especially those who live an active lifestyle, will be tempted to rush the recovery process. But this is to your own detriment. When you’re recovering from PCL reconstruction, it can take up to 6 months before the new and intact ligament is working to its full potential. However, your recovery may take longer – everyone is different.
A physiotherapist can help guide you through the recovery process, and our hospital has a talented team who can support you throughout your recovery.
Medically reviewed by Mr Sujith Konan - MBBS MD(res) MRCS FRCS(Tr&Orth), Honorary Associate Professor (UCLH)
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.
Appointment
You will have an initial consultation with a specialist knee surgeon.
Treatment plan
During this appointment, you will go through your medical history, have a knee exam and if needed, be referred for an up-to-date scan (such as X-rays, MRI or CT) of your knee. If surgery is recommended, your doctor will explain the risk and benefits of surgery and what to expect from recovery. Together, you will decide whether a PCL reconstruction is the best option for you.
Prehab
Your knee needs to be in the best condition possible before surgery, as this will lead to better outcomes. Once your swelling has gone down, you should follow your physiotherapist’s exercise programme. Exercises to strengthen your thigh muscles (quadriceps) are especially important after PCL injuries.
Pre-op assessment
If you decide to go ahead with surgery, you will need to come in for a pre-assessment, which is a standard ‘fitness for surgery’ check.
Surgery
You will be able to walk the same day with the help of a knee brace or crutches. You can go home the same day.
Aftercare
You will need to keep your wound clean and dry, take pain relief and have physiotherapy consistently. You will not be able to fly short haul for six weeks or long-haul for 12 weeks. We have an excellent therapies team at our hospital that can support you throughout your recovery.
Follow-Up
You will have a follow-up appointment with your doctor at two weeks, where any stitches will be removed. You may need further check-ups at 6 weeks, 12 weeks and 6 months.
Top Tips
Knee arthroscopies are common procedures. However, all surgeries carry risks, such as infection, developing a blood clot or having an unexpected reaction to the anaesthetic.
As such, make sure you follow your doctor’s advice, take diligent care of your wounds and don’t rush your recovery. You may also want to consider choosing lower-impact sports or activities that are easier on your knee after surgery.
Many people, especially those who live an active lifestyle, will be tempted to rush the recovery process. However, recovering from a PCL injury takes time. Be patient, follow your doctor’s advice and your outcomes will be much better.
Our hospital has a talented team of physiotherapists who can support you through your recovery.