Doctor Michael Wright, Orthopedic Sports Medicine Surgeon, is joined by Scott Doherty, Physician Assistant, at Missoula Bone & Joint Surgery Center. Dr. Wright was on his way into surgery to perform a Posterior Cruciate Ligament, PCL, repair of the knee joint.
The knee is structurally complex. It is held together by four ligaments (ACL, PCL, MCL, LCL) and two tendons (quadriceps and patellar). Two shock-absorbing pieces of cartilage called menisci, located between the femur and tibia, help cushion and stabilize the joint. It is composed of three bones. The thighbone (femur), sits on the larger leg bone (tibia). The kneecap (patella) glides in a groove on the end of the femur.
The PCL is a tough band of tissue that connects bone to bone. It is similar to the Anterior Cruciate Ligament, ACL, in that it crosses inside the knee joint to connect the thigh bone (femur) to the shin bone (tibia). The ligaments enable the knee to have the flexibility to move in various directions while maintaining stability. The ACL and PCL help to keep the joint aligned. The ACL and PCL counteract excessive forward and backward forces and prohibit displacement of the bones. The ACL and PCL control rotation of the tibia. You rotate your tibia when you turn your leg outward to push off the ground with the foot. For example, you use this motion to push off from the side to skate, or run, or move your body to get into a car seat.
PCL injuries usually are the result of the tibia being hit by an outside force when the leg is bent. Examples include; being tackled in football, falling on the shin, or in a car accident and the shin hits the dashboard. This type of injury is repaired in surgery using arthroscopic techniques.
Because initial symptoms can be vague, some people may not know that they have a posterior cruciate ligament injury until the pain worsens over time and the knee feels unstable. PCL tears can cause:
• Knee pain ranging from mild to moderate
• Rapid knee swelling and; tenderness
• Pain while kneeling, squatting, running, slowing down, or walking stairs or ramps
• Limping or problems walking
• Knee instability, a feeling that the knee is “giving out”
Your doctor will order X-Rays to see the condition of the bones in your knee and to identify fractures. It is not uncommon for bone or cartilage to be injured with the ligaments in a knee injury. Commonly, magnetic imaging (MRI) scans are used to best see the ligament injury, and confirm severity of the injury.
Your doctor may recommend over-the-counter or prescription pain medication. In some cases, people with a PCL tear, wear a knee brace to support the knee.
The goal of PCL repair surgery is to restore the function of the PCL to maintain the knees mobility, stability, and function, while preventing further injury.
During PCL surgery, the damaged PCL is removed and replaced with a healthy ligament – a graft. There are a few options for acquiring grafts. Grafts may be taken from another part of the body or from a donor cadaver. An orthopedic surgeon uses an arthroscope to perform surgery on a PCL tear.
An arthroscope is a very thin surgical instrument, about the size of a pencil. It contains a lens and lighting system that allows a surgeon to see inside a joint. The surgeon only needs to make small incisions and the joint does not have to be opened up fully. The arthroscope is attached to a miniature camera. The camera allows the orthopedic surgeon to view the magnified images on a video screen. Arthroscopic PCL repair is associated with less pain, reduced risk of infection, decreased swelling, and faster recovery times than open PCL surgery.
Surgically placed grafts may take several months to heal to the knee bones. How long it takes to recover depends on the severity of the injury, but usually the patient starts physical therapy at one to four weeks post-surgery. Physical therapy rehabilitationbegins as the swelling diminishes; to help decrease swelling, increase mobility and stability, and increase strength and knee function. A physical therapist will show you specific exercises to strengthen the quadriceps muscles and other muscles that support the knee joint. The goal of physical therapy is to strengthen the knee and restore function.
Here at Missoula Bone & Joint we have several doctors that specialize in arthroscopic surgery of the knee, hip and shoulder.