Posterior cruciate ligament (PCL) reconstruction is needed when a knee with a PCL tear keeps giving way during sports and physical activities despite full stengthening and rehabilitation of the muscles about the knee. Surprisingly, many people with an isolated PCL rupture manage well, and do not have ongoing problems with giving way of the knee. This is in contrast with patients with ACL (anterior cruciate ligament) ruptures, most of whom do badly, with recurrent giving way of the knee if not treated with surgical reconstruction.
The PCL is a big, thick ligament which has two bundles. For reconstruction, I take a strip of the quadricep tendon from above the kneecap with a block of kneecap bone attached, split the block and half the tendon graft into two, and using a fibreoptic scope (arthroscope) place the graft across the knee with the two bone blocks into separate tunnels on the top (femoral) side. Both ends are then fixed down with screws and a strong tie in addition at the lower (tibial) end. This is known as a double bundle PCL reconstruction.
Recovery is slower than with ACL reconstruction with a return to light running at 4-6 months and a sport return at 9-12 months. Bracing is used over the first 3-4 weeks only. The risk of failure of the PCL graft is also higher than that seen in ACL reconstructions- 2 or 3 grafts out of 10 may not give the degree of knee stability wished for.