The posterior cruciate ligament stabilises your knee. Discover expert care with Prof. Cavaignac for injury symptoms and advanced treatments.
Understanding the role of the Posterior Cruciate Ligament of the knee
The posterior cruciate ligament of the knee is essential to knee stability. Working together with the ACL, these “cruciate ligaments” form a cross in the centre of the joint, limiting unwanted movements. The cruciate ligament (posterior position) specifically prevents the shinbone from sliding backwards relative to the thighbone.
A posterior cruciate ligament knee injury disrupts this stability. Patients may find walking, descending stairs, or running challenging. If left untreated, such injuries can lead to progressive joint wear and arthritis.
Posterior cruciate ligament tear: symptoms and causes
For a posterior cruciate ligament tear, the symptoms are often more pronounced. Patients typically experience significant swelling, marked instability especially when walking downhill, and persistent discomfort when bending the knee. In some cases, there may be an audible “pop” at the time of injury, followed by difficulty bearing weight on the affected leg.
PCL tear, a sport injury
In the sporting context, posterior cruciate ligament injuries often result from high-impact trauma or awkward landings during play.
Rugby is one of the most affected disciplines. The nature of the sport (frequent collisions, tackles with the knee in a flexed position and heavy contact at speed) significantly increases the risk of PCL damage. These situations place the posterior structures of the knee under extreme stress. When not diagnosed early, such injuries may be mistakenly dismissed as simple bruising, delaying appropriate treatment and rehabilitation.
PCL damage symptoms
Patients suffering from a posterior cruciate ligament injury often describe a deep posterior cruciate ligament pain behind the knee, which may appear shortly after the trauma. Swelling typically follows within hours, accompanied by a sensation of instability or weakness. Many report difficulty walking on uneven ground or descending stairs, activities that require the knee to stabilise under load.
In more severe cases, one of the posterior cruciate ligament injury symptoms may be the knee unexpectedly “giving way,” compromising confidence in daily movements.
PCL damage causes
The main causes of posterior cruciate ligament injuries include:
- Direct impacts to the front of the knee, often occurring in car accidents (dashboard injuries).
- Falls onto a flexed knee during sports. This is particularly frequent in rugby, where tackles and pile-ups often force the knee into vulnerable positions under load.
- Severe hyperextension injuries, though these are less common.
Diagnosis: Clinical and Imaging Assessment
Professor Cavaignac performs a detailed physical examination, including the posterior drawer test. An MRI scan confirms the diagnosis, showing whether there is a partial tearor if it is a fully torn posterior cruciate ligament. Associated injuries to other knee structures, such as the posterolateral corner (PLC), can also be identified.
Personalised Treatment for a Posterior Cruciate Ligament Injury
Every posterior cruciate ligament injury requires an individualised approach to ensure the best outcome. Treatment depends on the severity of the damage, associated injuries and the patient’s activity level.
Conservative Management
For isolated and less severe cases, treatment for posterior cruciate ligament injury may involve:
- Rest and temporary activity modification
- A protective knee brace
- Personalised physiotherapy to restore muscular strength and joint stability
Surgical Management for Complex Injuries
In cases of posterior cruciate ligament tear with significant instability, or in complex injuries involving the PLC, surgery is required. Professor Cavaignac performs arthroscopic anatomical reconstruction using a minimally invasive transseptal approach.
This technique allows:
- Precise graft placement
- Preservation of healthy ligament tissue to promote healing
- Restoration of both anteroposterior and rotational stability
A key feature of his approach is the use of a knotless anchor for stabilising the posterolateral corner, simplifying femoral fixation and reducing the risk of complications.
Posterior Cruciate Ligament tear treatment: Non-Surgical Management of Grade III PCL Injuries
Recovery is an important part of the posterior cruciate ligament tear treatment and it is carefully staged. Discover our rehabilitation protocol.
Precautions
- Apply the PRICE protocol: Protect, Rest, Ice, Compress, Elevate.
- Begin progressive weight-bearing to gradually restore full loading capacity.
- Limit range of motion (ROM) from 0° to 90° in a prone position during the first two weeks, then increase as tolerated.
- No hyperextension allowed for the first 12 weeks.
- Avoid posterior tibial translation: no isolated hamstring work before week 12.
- Wear a dynamic PCL brace continuously, including during physical therapy and sleep, for a minimum of 12 weeks.
Goals
- Protect the injured PCL during early healing.
- Reduce swelling, restore joint mobility and reactivate the quadriceps.
- Maintain or retrain gait pattern.
- Initiate patient education and autonomy.
Precautions
- Continue to avoid hyperextension until week 12.
- Still no hamstring-specific exercises to prevent tibial sag.
- Perform only bilateral strengthening exercises, limited to a maximum of 70° knee flexion.
- Maintain full-time use of the dynamic brace.
- Full ROM is allowed in both supine and prone positions.
Goals
- Maintain PCL protection while increasing joint use.
- Achieve full joint ROM.
- Normalise gait pattern and begin crutch weaning.
- Start bilateral strengthening (≤70° knee flexion) and unilateral isometric work.
- Focus on muscular endurance training (e.g. 3 sets of 20 repetitions).
Goals
- Discontinue the dynamic brace if clinical stability and strength permit.
- Progress to strength-based training, exceeding 70° of knee flexion.
- Initiate isolated hamstring strengthening (from week 12 onwards).
- Introduce sport-specific drills gradually, depending on tolerance.
Assessment of Healing
- Around week 15, perform a clinical exam and/or stress radiographs to objectively assess ligament healing and joint stability.
Return to Non-Contact Sports
- Allowed only with medical clearance.
Return to Contact Sports
- Permitted only if all of the following criteria are met:
- Full and pain-free range of motion.
- Quadriceps strength at least 85–90% of the healthy leg.
- No clinical signs or sensation of instability.
- Minimum 90% performance on sport-specific functional tests.
- Demonstrated psychological readiness: the athlete must feel confident and unrestrained.
Why Is Rehabilitation Important?
A structured rehabilitation prevents further injury, strengthens the knee, and restores your confidence in daily activities and sports.
The Risks of Leaving a Posterior Cruciate Ligament Injury Untreated
Untreated knee injury of the posterior cruciate ligament often results in chronic instability. Additionally, patients risk damaging other knee structures and experiencing progressive degeneration, making future surgical reconstructions more difficult.
Prompt diagnosis and appropriate posterior cruciate ligament injury treatment are essential for protecting knee function.
Why Trust Professor Cavaignac with Your Posterior Cruciate Ligament?
Professor Etienne Cavaignac is a recognised expert in knee surgery and sports traumatology, specialising in arthroscopic reconstruction of the posterior cruciate ligament (PCL). Whether the injury is isolated or involves complex multiligament damage, his personalised approach offers the best chance for a full recovery.
Based in the rugby heartland of South-West France, Professor Cavaignac has extensive experience treating PCL injuries in professional rugby players. His deep understanding of sport-specific demands ensures optimal care for athletes and active individuals alike.
This expertise allows him to offer care that meets the highest demands of sporting performance and recovery.
His care combines:
- Precise diagnosis using clinical assessment and MRI.
- Minimally invasive surgery using cutting-edge arthroscopic techniques.
- A tailored rehabilitation plan, adapted to your specific case.
Professor Cavaignac’s approach ensures that each patient receives treatment aligned with the latest scientific evidence and clinical best practices.
Restore Your Knee Stability with Confidence
If you suspect a posterior cruciate ligament sprain or are suffering from posterior cruciate ligament pain, seek an expert opinion. Professor Cavaignac will assess your situation and propose the most appropriate care for a rupture of the posterior cruciate ligament, guiding you through recovery and helping you return to your daily activities and sports.