PCL Tear
What Is an PCL Tear?
The posterior cruciate ligament (PCL) is one of the four major ligaments that stabilize the knee. Located toward the back of the joint, it connects the femur to the tibia and works opposite the ACL — preventing the shinbone from sliding too far backward relative to the thighbone. The PCL is the strongest ligament in the knee, so it typically takes a significant force to injure it.
What Causes a PCL Tear?
Because the PCL is so strong, PCL tears usually result from higher-energy events than other ligament injuries, including:
- A direct blow to the front of the shinbone while the knee is bent (a classic “dashboard injury” in car accidents)
- Falling directly onto a bent knee
- Hyperextending the knee during sports
- Twisting injuries combined with a direct impact
PCL tears frequently occur together with injuries to other knee ligaments, particularly when the injury involves significant force.
What Are the Symptoms of a PCL Tear?
Symptoms of a PCL tear can be more subtle than an ACL tear, which sometimes leads to delayed diagnosis. Common symptoms include:
- Pain toward the back of the knee
- Swelling, though often less dramatic than with an ACL tear
- Stiffness and difficulty with full range of motion
- A vague sense of knee instability, especially walking downhill or downstairs
- Difficulty putting weight through the leg in the acute period
Is a PCL Tear Less Noticeable Than an ACL Tear?
Yes, this is one of the more distinctive features of a PCL injury. Because the PCL doesn’t cause the same forward-sliding instability that an ACL tear does, many patients with an isolated PCL tear can walk on a relatively stable-feeling knee soon after injury. This is also why PCL tears are sometimes missed on initial evaluation and only diagnosed once ongoing symptoms or an MRI reveal the injury.
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Treatment Options for a PCL Tear
Many isolated PCL tears, particularly partial tears, respond well to nonsurgical treatment:
- A structured physical therapy program focused on strengthening the quadriceps muscles, which help compensate for a PCL injury
- Bracing during the initial healing period
- Gradual return to activity as strength and stability improve
Surgery is generally reserved for complete tears with significant instability, PCL tears combined with other ligament injuries, or cases where nonsurgical treatment fails to restore adequate function. PCL reconstruction uses a tendon graft to rebuild the torn ligament, similar in concept to ACL reconstruction. Learn more on our PCL Surgery page.
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.