The posterior cruciate ligament is one of four important ligaments within the knee. It keeps the lower leg bone (tibia) from sliding posterior to the thigh bone (femur). In many cases, injuries which tear the posterior cruciate ligament damage other cartilages or ligaments in the knee as well.
Causes of PCL Injuries
The injuries of PCL are often caused by a blow to the knee when it is bent. Some common causes include falling on the knee when it is bent and striking the knee towards the dashboard during an auto accident. Sports injuries also commonly cause PCL injuries such as during playing baseball, skiing, football, and soccer.
An injury to the PCL can possibly cause mild to acute damage. Doctors have generally categorized PCL injuries in the groups given below:
● Grade 1: Partial tear in PCL
● Grade 2: The ligament is slightly torn and is also looser as compared to the damage in Grade 1
● Grade 3: Complete tearing of the ligament and the knee becomes unbalanced.
● Grade 4: A damage of the PCL along with other ligaments in the knee.
The problems of PCL can be chronic or acute, depending upon its time of development. Sudden injury results in the acute type of PCL problems whereas Chronic PCL problems are caused due to an injury which evolves over time.
After a PCL injury, people mostly think that they have a slight knee problem. The symptoms which might develop along with knee pain include swelling (mild to severe), pain and instability after the injury, trouble bearing weight on the knee, troubled walking, and wobbly sensation in the knee. A PCL tear can also result in osteoarthritis in the knee.
X-rays are used to analyze the fractures. Particularly stress X-rays can analyze laxity of the PCL. Moreover, MRI (Magnetic Resonance Imaging) is used in many cases to analyze the level of PCL injury and other injuries.
● Initial treatment involves physical remedy to strengthen the quadriceps and rest.
● Surgical reconstruction is suggested when a patient has continuous instability in spite of completion of a program for physical therapy and sufficient quadriceps strength.
● Surgery includes reconstructing the Posterior Cruciate Ligament. Surgeons use allograft (donor tissue) or a patient’s own tissue (generally a piece of the quadriceps tendon) to recreate the PCL. Post-Operative Care or Guidance
● Patients might need to rest in the hospital after surgery for a day or two for pain control.
● Brace (or splint) and crutches are used nearly for one month after surgery.
● After surgery, physical therapy starts soon to regain the range of strength and motion.
● After surgery, it takes almost six to nine months of time for a full recovery. Many athletes take approximately one year to recover before fully returning to athletics.
There are many treatments including physical therapy and surgery. However, it is important to consult an experienced doctor as he suggests the best options according to the patient's condition.
Do not neglect PCL injury.
There are many situations under which people may go through joint or muscle damage. There are other portions that may also go through the side effects of such damage. During the damage, a knee ligament might be overstretched (sprained), or at times even torn. A ligament tear can be incomplete (only a portion of the filaments that make up the tendon are torn) or complete (the tendon is torn totally). Knee tendon wounds can bring about pain, swelling, wounding and lessen the movement of your knee. Your knee joint may feel unsteady and you may walk with a limp.
There are four tendons in the knee that could get damage:
Side effects can include the following:
Treatments that can help elevate the pain are as follows:
Arthroscopy has brought about a revolutionary change in the way doctors visualize, diagnose, and then treat problems in knee joints, elbow joints, shoulder joints, ankle joints, and hip joints. For performing Arthroscopy, the doctor makes an incision on the skin of the patient and inserts a slender instrument through the incision. The instrument contains a small lens along with a lighting system to illuminate and magnify structures inside the joint. This instrument is known as an arthroscope, and it also contains a miniature camera.
With the help of the camera, the surgeon can visualize the entire interior chambers of the joint. So, the primary benefit of Arthroscopy lies in the visualization and treatment of various joints through a very small incision. This implies that the doctor does not need to make a large incision or cut open the joint for surgery.
The camera displays all the images on a television screen that helps the surgeon to look for problems such as tears, scars, inflammations, etc., inside the joint. He can see the ligaments, cartilage, stuff under the kneecap, etc., to determine the type and amount of injury. He can proceed to repair or rectify the problem accordingly.
What Is the Benefit of Arthroscopy?
Before Arthroscopy, doctors used to diagnose joint diseases and injuries with the help of physical examination, medical history, X-ray, MRI, and CT scan. However, such diagnosis is usually not as perfect as a diagnosis made by looking through the arthroscope and into the joint cavity.
Joints like shoulder, knee, hip, wrist, etc., may suffer from a number of diseases, apart from injuries. These can damage not only bones, but also ligaments, cartilage, tendons, and muscles. Diagnosing of a fracture can be done through X-rays. However, the diagnosis of cartilage, tendon, or muscle damage is difficult to make without Arthroscopy.
Conditions Affecting Joints in which Arthroscopy Can Be Used:
Some of the most common condition where Arthroscopy can be used are:
Inflammation: Inflammation of the lining of the joint cavity, also known as Synovitis, can affect all joints including shoulder, wrist, elbow, and ankle joint.
Injuries: Injuries beset joints that include all joints. However, there are some typical injuries that beset specific joints. Some of the common injuries are:
Shoulder joints usually suffer from rotator cuff tendon tear, dislocations, and impingement syndrome.
The most common injuries in knee joints are a meniscal tear, anterior cruciate ligament tear, and chondromalacia
For wrist, carpal tunnel syndrome is the most common form of injury usually formed by repeated abuse of the carpal tunnel.
Arthroscopy makes it easy to diagnose and treat each of these injuries.
Problems Treated by Arthroscopy:
Apart from injuries, other problems that can be treated by Arthroscopy are associated with arthritis. In fact, there are several injuries and problems where a combination of standard and arthroscopic surgeries is needed. These include:
Rotator cuff surgery for a shoulder injury.
Repair of torn cartilage in the shoulder or knee.
Reconstruction of anterior cruciate ligament of the knee.
Releasing the carpal tunnel of the wrist.
Repairing torn ligaments.
Although Arthroscopy enables the surgeon to view the cavities of all types of joints, it is primarily used to view and fix six joints that include shoulders, knees, ankles, elbows, wrists, and hip. With new and innovative technologies, more and more complex and smaller joints are being treated with Arthroscopy.
Arthroscopy is very useful in many injuries and joint related problems. However, it is always advisable to consult a doctor before going for this type of surgery as every patient and condition is different from the other.
Ankle instability is often caused by damage to the lateral ankle ligaments. This typically causes strain and in further severe forms results in injury to the ligaments. This may further cause a feeling of instability in the ankle and eventually predispose the individual to get recurrent ankle sprains even with very minimal twists.
The symptoms of ankle instability include weakness and wobbliness in the ankle or a continuous feeling of falling down while walking on uneven surfaces. People with ankle instability often experience the feeling of rolling outwards or giving way. Sometimes, after the initial injury that led to the condition of the unstable ankle, patients often feel that something has not been right ever since that injury causing them to frequently lose their balance. The condition may result in the swelling of the ankle and increased vulnerability towards twists or sprains resulting from the weakness in the ankle and its inability to support the body weight.
More often than not, patients with ankle instability may be treated without surgery by merely supporting the muscles that control the hinge joint of the ankle. This is done using supportive braces or shoes to reduce the threat of frequent ankle sprains and by avoiding activities that involve higher risk.
The treatment for ankle instability involves a range of exercises that focus on the strengthening of muscles to account for the balance provided by the ligament formerly. If pain is encountered while performing specific activities, patients are advised to use a tape or special shoes while performing the activity. If the problem still persists and goes extreme, the individual is recommended to opt for surgery.
The surgical intervention for ankle instability can be categorized under anatomic reconstruction and peroneal substitution ligament reconstruction. The former aims to allow the stretched or torn ligament to heal in a shortened position by using the individual's own tissue or a cadaver tendon. In the latter, the torn ligament is completely replaced by using another tendon from the patient's own ankle.
Both the methods have their own pros and cons and the choice of a particular method is dependent on the physician after careful examination of the individual case. In most cases, the patient is advised physiotherapy or exercise and surgery is, but rarely advised. Even after the surgery, patients are asked to undergo a variety of exercise techniques and therapy.
Our knee is supported by several ligaments which help in movement. But what happens if you tear a crucial knee ligament? Tears or 'ruptures' in ligaments of the knee are common in sportsmen and/or accident victims, especially of the anterior cruciate ligament (ACL).
Though the ACL is not the only ligament of the knee, it is one of the most crucial to maintain stability of the knee joint. Any tear of this ligament frequently leads to chronic knee instability. When a tear in this ligament happens, patients know it immediately as they report feeling or hearing a “pop” along with pain and a feeling of an unstable knee.
Types of ACL injuries
ACL injuries can be classified by the amount of damage to the ligament. They can be partial or complete tears.
There are many different ways that this ligament can be reconstructed depending on the age, activity level, and gender of the patient. ACL tears can be treated using arthroscopy and minimally invasive surgical techniques.
Though non-surgical methods are available, like rehabilitation and physical therapy, they don’t help much with complete ACL tears.
1. Exercises- this helps to increase the range of motion of the injured knee, decrease the amount of swelling, and maintain muscle control.
2. Arthroscopic surgery for reconstruction of the ACL
It can be of 2 types- Repair and reconstruction of the ACL.
Knee arthroscopic surgery is a minimally invasive surgery which is done using pin hole cameras and under general or local anesthesia. The torn ligament is removed and the graft is introduced in its place and secured.
Post surgery outlook
As long as the operated knee is cared for properly and other injuries are avoided, the benefits of the surgery are usually permanent.
Posterior cruciate ligament helps to hold the knee together. If there is a ligament tear, it results in pain, swelling and redness. The cruciate ligament connects the important tibia to the femur. Any injury to the posterior cruciate ligament may take months to heal and has the potential to cause instability and disability.
Signs and symptoms: The symptoms and signs of a posterior cruciate ligament injury include moderate to severe pain resulting in difficulty in walking and limp. The knee swells to a large proportion within minutes of the injury causing the knee to feel loose. There are certain situations when a patient doesn’t feel a thing about the injury and then there is a case where the pain worsens every day.
Causes: A tear in the posterior cruciate ligament appears when the shin bone gets hit. It can also occur when a person falls down with a bent knee. Some common injuries of this sort occur during motor vehicle accidents and contact sports. Apart from this, sudden accidents hitting the back portion of the knee can also result in ligament injury of the posterior cruciate ligament. Historically, men have been found to be more risk-prone to this condition as compared to women.
What are the complications?
A posterior cruciate ligament injury may result in damage to other ligaments and bones within the knee. Based on the type of injury, the long term implications are predicted by healthcare professionals. The risk of developing arthritis and long term chronic pain exists in this condition.
If you have injured just your posterior cruciate ligament, your injury may heal quite well without surgery doctor recommend simple, nonsurgical options.
Your doctor may recommend surgery if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the posterior cruciate ligament, surgery is almost always necessary.
Surgical procedures to repair posterior cruciate ligaments continue to improve. More advanced techniques help patients resume a wider range of activities after rehabilitation.
Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion. Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.
ACL Injury (meniscal injury) means torn in one of the important ligament of knee joint, joining the upper leg bone and the lower leg bone, eventually tearing and trapping the cushion pads supporting the knee joints. These injuries usually occur during sports activities, like soccer, basketball, football, gymnastics, tennis, volleyball, etc.
An untreated ACL injury can lead to a condition called an ACL deficiency. This can cause a lot of problems with regard to knee movements as the bones may rub against each other, causing a lot of pain. In some cases, the cartilage covering the ends of the bones may get damaged, eventually tearing and trapping the cushion pads supporting the knee joints.
Signs and symptoms of the anterior cruciate ligament may include:
1. You are unable to move properly.
2. You experience immense pain while walking up and down stairs.
3. You are unable to engage much in physical activities.
4. Your knee begins to swell gradually.
5. You can sense a loud popping sensation when moving your knee.
6. You experience feelings of instability in running, climbing stairs, waking fast or walking on uneven surface (feel like sudden unlocking of knee joint).
Anterior cruciate ligament injuries generally occur during sports. Here are some common possible instances that might happen during a game:
1. Sudden arrest in motion
2. An unsteady landing from a jump
3. Direct blows to the knee from tackles
4. Sudden shifts in direction
Treatment of ACL injuries normally involves the following:
1. Immediate medical attention along with intense first aid care
2. Sincere adherence to the R.I.C.E model of self-care -
3. Success rehabilitative therapy for several weeks
4. Anterior cruciate ligament surgery or reconstruction - In case of complete ACL tear or tear involving more then 50 of ACL fibres and also showing major laxity in knee joint on clinical examination, this procedure is followed.
The anterior cruciate ligament is one of the most delicate yet vital ligaments that holds the knee bones in place and stabilizes the movement. Injury to the ligament, on account of a sprain, can prove to be a cause of severe distress. This may lead to a partial or a complete destabilization of the knee joints and impair the normal movements to a great extent.
Causes: Some of the most common causes of this sort of a ligament tear are accidental injuries during a sporting activity, unexpected collision or incorrect body postures. This is a fairly common occurrence among the athletes. However, the physiological and neuromuscular controls make women more susceptible to damage to the Anterior Cruciate Ligament than men.
There are two cruciate ligaments in our body, i.e. the anterior and the posterior cruciate ligaments. They run in crosses to connect the insides of the knee joints. They regulate the back and forth movement of your knees. They therefore, may incur substantial damage through sudden movements like jerks or an abrupt change of direction; the degree of tear may vary from minor strains to complete detachment.
Accordingly, treatments are available to cure the distress. The treatments may either be surgical or nonsurgical, depending about the extent of the injury as well as the age of the patient. A complete tear in the ligament necessitates surgery for recovery. However, one may choose to opt for other non - surgical methods to minimize the damage.
Some of the most effective treatments for a tear in the anterior cruciate ligament have been enlisted below:
1. Bracing: Wearing a brace or using a crutch for the purpose of movement can accord the knees with some stability. It also keeps the joints intact and alleviates pain.
2. Physiotherapy: Once the inflammation reduces, you may opt for physiotherapy to restore movement and reduce the pain. Heat and Ice therapies work as ideal adjuvants to physiotherapy in such cases.
3. Surgery: Regrowth of the anterior cruciate ligament may be possible through a surgical process of grafting. This enables the tissues to repair themselves. Knee caps and adequate rest accord better rehabilitation. The recovery is faster and steadier in this process.
In general, anterior cruciate ligament injuries or ACL injuries, are understood as tearing of front knee ligament joining the thigh bone and the leg bone. This can vary from minor injuries, such as small ligament tears, to more serious cases like complete tears.
Common cause of such injuries are twisting which may be due to sporting activity (Common in Football, wrestling, Badminton, etc.) or any lifestyle injury - slip from stairs, two-wheelers accident, dancing injuries.
Lack of confidence in the knee, frequent falls, difficulty in climbing stairs, weakness in thigh and continuous pain.
In case of Minor tears and low demand knee, you can be treated with Guided rehabilitation, nutritional support and gradual return to sports.
In cases of major tears and high demand knee – Reconstruction of the ligament can be done to regain active working of your knee joint. This procedure is done with minimal invasive surgery called arthroscopy so you can return to your work very early.
• Can I recover without surgery with help of physiotherapy and PRP (Stem cell treatment) in case of complete tears –
To understand it better, the stability of knee joint provided primarily by Ligaments (elastic structures binding bones) and secondarily by muscles surrounding so in case of minor tear your physio strengthen supporting muscles to compensate this deficit but in no case, this extra muscle can compensate for complete tears and high demand knee.
• What if I do not undergo ACL surgery –
In case of falling again due to the instability of your joint, you may have further damages of remaining ligaments and other body structures. moreover this loose knee joint will lead to degenerative ( Old age changes ) to your joint even at a young age.