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Posterior Cruciate Ligament Reconstruction
Dr. James Chen, M.D. - In San Francisco, CA

Dr. Chen’s surgical technique for PCL reconstruction tunnel placement:

An arthroscopic procedure performed to replace a torn or incompetent Posterior Cruciate Ligament (PCL) with a tendon graft. Two small incisions are made on the front of the knee. An arthroscopic camera and instruments are used to clear the torn PCL away from its bone attachment sites in the knee. A tunnel is drilled at the femoral attachment site from inside the knee. A third, very small, incision is made just below the knee and a specialized drill guide and drill bit are used to drill a small hole to the tibial attachment site at the back of the knee. The tip of the drill bit flips to the side and reverse drills a tunnel in posterior tibia. The graft is then introduced into the knee using passing sutures that are shuttled through the tunnels to the exterior of the leg. These sutures are tensioned bringing either end of the graft into the tunnels. Metal buttons attached to the sutures are seated on the outside of the bone and allow the graft to be secured in place.

Dr. Chen’s surgical technique for PCL graft passage:

Common Questions about Posterior Cruciate Ligament Reconstruction

What is the posterior cruciate ligament?

The PCL is the posterior counterpart to the ACL. The PCL is a stout ligament that prevents your tibial from moving backwards too far.

How do PCL injuries occur?

Typically the patient has a direct fall onto the front of his knee. In high energy trauma such as a car accident it can occur when the knee hits the dashboard. It can also occur from a hyper-extension injury.

When should I have surgery on the PCL?

Most PCL tears are treated non-surgically in a special knee brace. Grade 3 PCL tears in a high level athlete are candidates for PCL reconstruction. PCL surgeries are performed most commonly in the setting of a multiple ligament injury to the knee.

How is PCL reconstruction performed?

A socket is drilled into the femur and tibia. An allograft is then implanted and tensioned as the new ligament. Buttons or plastic screws are used to fixate the ligament in place.

What is the expected stability outcome after PCL surgery?

In general a patient's knee stability will improve by one or one and a half grades. A patient with Grade 3 PCL laxity will improve to Grade 2 or Grade 1.5.

What is the rehabilitation after PCL surgery?

After surgery the patient is placed in a PCL brace and must use crutches for 6 weeks. This is followed by physical therapy for 4 months. Full return to sports can take 8 to 10 months.

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