Pcl pp

PCLPosterior cruciate ligamentDr. Dhruv TanejaM.P.T, MIAPAssistant Professor

PCL with functions• The posterior cruciate ligament (or PCL) is one of the

four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur.

• The PCL is a strong fan shaped and intracapsular ligament along with the anterior cruciate ligament(ACL).

• They are both isolated from the fluid-filled synovial cavity, with the synovial membrane wrapped around them.

• It has two partsa. Anterolateralb. posteromedial

Function of PCL • The function of the PCL is to prevent the femur

from sliding off the anterior edge of the tibia.

• Prevents hyperflexion of the knee to a lessor extent with ACL but its main function is to check extension and hyperextension.

• It also helps in checking the rotational movements with ACL.

• To prevent the tibia from displacing posterior to the femur.*****

MECHANISM OF INJURY• DIRECT BLOW TO THE KNEE WHILE IT IS

FLEXED(dashboard injury)

• FALLING HARD ON THE KNEE

• Hyperextension injury

• (any mechanism that involves the knee to be forced posteriorly can leads to pcl injury).

Classification • Classification based on posterior subluxation of tibia

relative to femoral condyles (with knee in 90° of flexion)• Grade I (partial)

• 1-5 mm posterior tibial translation• tibia remains anterior to the femoral condyles

• Grade II (complete isolated)• 6-10 mm posterior tibial translation• complete injury in which the anterior tibia is flush with the

femoral condyles• Grade III (combined PCL and capsuloligamentous)

• >10 mm posterior tibial translation• tibia is posterior to the femoral condyles and often indicates

an associated ACL and/or PLC injury

Diagnosis

• History• Special tests (please name it )• M.R.I/C.T scan

Note:- whoever will name the special tests has to explain it

Special tests• Posterior drawers test***• Reverse lachmans test*• Godfreys test

Post. drawers test

Reverse lachmans test

Godfreys test

Treatment • Complete rest• Surgical intervention• Physiotherapy rehabilitaion

Rest • Complete rest is advised within a supportive brace

for grade 1 and grade 2 tear of PCL, which generally heals on its own.

Surgery :-Surgery is performed for grade 3 and grade 4 tearing.Graft is taken from either hamstrings or achilles tendon.Ligament reconstruction arthroscopy is performed.

Rehabilitation • Acute stage(the aim of acute stage stage Rx is to control pain

and inflammation).1. PRICE 2. Ankle toe movements3. Quadriceps sets at the earliest.4. Cryotherapy- ice packs for 15 mins every hour.5. U.S.6. IFT7. TENS

(PRECAUTION:- Protect the knee from posterior or extension stresses).

Subacute stage

1. SLR 2. QUADRICEDPS SETS 3. SELF ASSISSTED KNEE ROM EXERCISES4. HAMSTRINGS SETS 5. DELORME,S EXS

CHRONIC STAGE

1. Focus on quadriceps and hamstrings sets as they are the one which will be giving trouble to the patient.

2. Focus on hip flexors and extensors aswell.

• Leg lifts in standing with brace on for balance and hip strength

Progression criteria

• Patient may progress to Phase II if they have met the above stated goals and have

• • Pain free gait using brace without crutches,• • No effusion• • Knee flexion to 90°

Progression criteria • • Patient may progress to Phase III if they have

met the above stated goals and• have• • Normal gait on all surfaces• • Ability to carry out functional movements

without unloading affected leg and• without pain, while demonstrating good control• • Single-leg balance greater than 15 seconds• • Full range of motion.

Progression criteria• • Patient may progress to Phase IV if they have

met the above stated goals and have• • Normal gait on all surfaces• • Ability to carry out multi-plane functional

movements with out unloading affected leg or pain, while demonstrating good control

• • Ability to land from a sagittal, frontal and transverse plane leap with good control and balance

Return to sport/work criteria• Dynamic neuromuscular control with multi-plane

activities, without instability,• pain or swelling