 |
A damaged PCL will not necessarily require surgery for a full recovery. Differences in the severity and in the type of injury will dictate the treatment decisions, as will the degree of athletic activity that the patient wishes to pursue after treatment. PCL injuries may range from minor sprains to complete tears of the ligament, and some patients, even with quite severe injuries, may choose to not undergo surgery. However, a completely torn PCL cannot rebuild itself, surgery to reattach or reconstruct the ligament is usually recommended. Less active patients with a complete tear may not always require this procedure.
|
|
|
|
|
|
|
| Non-surgical treatments are typically suitable for patients with minor sprains and pulls. These conditions may be fully treatable with physical therapy methods that recondition the PCL through exercise and gradual rehabilitation.
Even with serious PCL injuries, patients with less active lifestyles may also be candidates for non-surgical treatments. Continued gentle use of the injured knee may allow older and moderately active patients to avoid surgical treatment.
Some patients may be suitable for both surgical and non-surgical procedures. In these cases, patients that expect to resume an athletic and active life after treatment will likely benefit more from surgery than from non-surgical treatment.
|
|
Knee: Compression Sleeves
Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.
Knee compression sleeves can be used to treat:
Light swelling.
Light knee strains.
Chronic inflammation.
Degenerative joint disease.
|
Knee: Support
A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion
and provide compression to aid healing and reduce pain and swelling.
Patients suffering from knee strains or inflammation will usually be
directed to use a support during daily activities.
The thin and flexible construction of the support allows for normal
movement of the knee and also allows the support to be worn under
loose fitting clothing. To prevent harmful pressure to certain
structures, the support applies differing compression around the
knee. The sides of the joint receive intermittent pressure to help
stimulate blood flow while the rear of the support fits relatively
loose to prevent constriction of circulation. The kneecap is aided
in positioning, but remains free of compression to allow its natural
movement.
Knee supports can be used to treat:
Strains
Sprains
Inflammation
Chondromalacia patella
|
Knee Braces
Knee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.
Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.
Knee braces can be used to treat:
Pre-operative ACL/PCL ruptures or injuries
Non-surgical ACL/PCL injuries
General knee instability
Pre/post joint replacement with ligament instability
Grade II or III ligament sprains.
|
|
|
|
|
 |
| A torn PCL is usually difficult to stitch together after injury because the torn ends are frayed and difficult to manage. Most often, the torn ligament is completely replaced with material from the patellar tendon, though the ligament can also be supplemented with synthetic material.
An arthroscope is inserted into the knee joint through a small incision in the skin. The arthroscope contains a tiny fiber optic camera and is used to project images onto a monitor which the doctor uses to view the inside of the knee.
Fluid is introduced to the knee through another incision to clear away any blood and to distend the joint. A third incision is made to allow working instruments, such as scissors or a knife, into the joint. As the doctor views the interior of the knee from the monitor, he is able to work the surgical instruments with one hand while placing the arthroscope with the other hand.
|
Knee: Ligament Brace
Functional braces are designed to control abnormal motion of an unstable knee. Because ligaments help stabilize the knee, and a torn ligament leads to instability, these braces are also called Ligament Braces. The intent is to allow a previously injured athlete to compete at a higher level than they would otherwise be able to without the brace. The brace is designed to support either a newly reconstructed ligament such as the ACL, or a weakened or injured ligament, which is being treated in a conservative manner. The role of a functional brace is to increase stability to a previously injured knee.
Type of Injuries:
Pre-operative ACL/PCL ruptures/injuries
Non-surgical ACL/PCL injuries
General knee instability
Pre/post joint replacement with ligament instability.
|
|
NSAIDs
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
|
|
Knee: Cold Therapy
Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.
Cold therapy can be used to treat:
Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries. Knee Examples include:
Pre-operative ACL/PCL injuries.
Non-surgical ACL/PCL injuries.
General knee pain or swelling.
Soft tissue injuries.
|
|
|
|
The technology involved in the reconstruction or repair of an injured posterior cruciate ligament has significantly evolved over the last several years. Most orthopaedic surgeons commonly utilize the bone-patellar tendon-bone method of reconstructing the ligament. In order to securely fasten this replacement ligament to the femur and the tibia, screws are placed next to the bony portion of the graft within the tunnels that have been drilled in these bones. These screws, known as interference screws push the graft firmly against the inside of the bone tunnel to assist in the healing process. These screws typically are made of metal (titanium) or a material that gradually dissolves after the healing process is complete. This latter type of screw is known as a bio-absorbable screw. Each type of screw has its strong points.
Metal (titanium) Screws: Very strong throughout the post-operative rehabilitation. These screws stay in forever, and do not dissolve after the healing is complete.
Bio-Absorbable Screws: Strong throughout the critical early part of the rehabilitation process. These screws gradually dissolve, and lose their strength, but only after the new ligament has healed and become part of the knee.
Either option is a very acceptable alternative, but you should consult your surgeon to determine which type of implant is the best option for you.
|
|
The source of the replacement graft for a PCL reconstruction can come from different places and consist of different parts. Frequently mentioned terms are autografts and allografts. An autograft comes from your body. The advantage of this type of graft is that it is readily available and is completely compatible with you, as it is already part of your body. The disadvantage of using an autograft is that it was originally intended for some other purpose. The function of the muscle or ligament from which the graft was taken may be slightly compromised if this type of graft is used. An allograft comes from a human cadaver. The advantage of this type of graft is that it does not require taking a piece of tissue from another of your important parts. The disadvantage is that the tissue must be carefully processed and sterilized to make it free of disease and viruses, as well as make it compatible with your body and immune system. The sterilization process can weaken or change the physical characteristics of the graft.
Synthetic materials are occasionally used to increase the strength of both of these types of grafts.
The structures most often used to make a replacement graft include bone-patellar tendon-bone grafts, quadrupled semitendinosus/gracilis (hamstring) tendon grafts, or bone-quadriceps grafts. With appropriate surgical technique and rehabilitation, all of these grafts are suitable for PCL reconstruction. The autograft bone-patellar tendon-bone and the hamstring tendon grafts are the most commonly used grafts.
The bone-patellar tendon-bone graft is most frequently chosen for young, high-demand athletes because of the graft's strength, stiffness, durability, and long-term success rate in this type of patient. This graft allows for the earliest return to competitive sports.
The advantages of the hamstring (semitendinosus/gracilis) graft include a smaller surgical incision, and a thicker tendinous portion of the graft.
The advantages of the quadriceps tendon graft include a thick tendinous portion of the graft and a bony portion at one end of the graft. A potential disadvantage of the quadriceps graft is the size and the location of the donor-site scar.
As with all surgical procedures and options, consult your surgeon to determine which option is best for you and your knee.
|
About the Review Team
|
|
