posterior curciate liagment injury, machanisum of injury, type of injury, special test, associated injuries ti PCL injury, physiotherapy treatment posteior sag test, posterior drawer test, abduction stress test, adduction stress test, day wie trsetment

1. Physiotherapy In orthopedic-II
Posterior cruciate liagment
By- kajal sanoya

3. Introduction
• The posterior cruciate ligament (PCL) is the
strongest and largest intra-articular ligament
in human knee and the primary posterior
stabilizer of the knee.
• It comprises of 2 functional bundles: the
larger anterolateral bundle (ALB) and the
smaller posteromedial bundle (PMB).

5. Attachments
• Posterior curciate liagment begins form the
posterior part of intercondylar area of tibia,
runs upwards, forwards and medially and is
attached to the anterior part of lateral surface
of medial condyle of femur .

6. When this ligament injured ?
• This ligament is damaged if the anterior
aspect of the tibia is struck with the knee
semi-flexed so as to force the tibia backwards
on to the femur

8. Mechanism of injury
• Hyperflexion
• Falling on bent knee with foot plantar flexed
• Hit on anterior tibia
• Dashboard injury
• Knee dislocation (rare)
• It may be tear of PCL or bony avulsion of PCL

10. Pathoanatomy
• The ligament may tear at either of its
attachment. Sometimes, it takes a chip of
bone from its attachment. The ligament may
be torn in its substance (mid-substance tear).
The severity of the tear varies from a rupture
of just a few fibers to a complete tear.

11. Conti…
• It may be an 'isolated' ligament injury, or more
than one ligaments may be injured. The
combination depends upon the direction and
severity of the force. Rarely, in a very severe
injury, the knee may get dislocated and a
number of ligaments injured.

12. Biomechanics
• Secondary stabilizer of knee preventing excessive
rotation specifially between 90-120 knee flexion
• PCL ruptures have greatest effect at 90 of knee
flexion, and thus , the integrity of PCL should be
tested clinically at 90 of knee flexion
• PCL provides resistance to internal rotation
beyond 90 of knee flexion
• PCL plays important role in rotational stability,
espeically beyond 90 flexion

14. Types of PCL injuries
• PCL sprain
• PCL isolated tear
• PCL tear along with ACL tear
• PCL damaged along with MCL injuries
• PCL injury with meniscus injury
• Posterolateral corner injury

16. Grades of PCL sprain
• Grade1- a partial tear is present in ligament.
• Garde2 –there’s a partial tear &the ligament
feels loose
• Grade3- the ligament is completely torn & the
knee is unstable.
• Garde4- the PCL is injured & another knee
ligament is damaged.

18. Can you walk with PCL injury ?
• It depends, in mild cases, people may still be
able to walk but no able to transmit full
weight bearing on affected knee
• Walking is not possible with severe PCL tear &
with multiple ligament injury.

20. Clinical presentation
• Patient usually able to walk with mild tear but
complain about difficulty in weight bearing
• Pop sound at back of knee
• Swelling in popliteal fossa
• Tenderness
• Stiffness
• Trouble going down stairs
• Pain worsen over time
• Feeling of instability of knee
• Wobbly sensation

21. Diagnosis
• If isolated PCL injury MRI is helpful
• CT scan and X-rays are done in multiple
injuries along with multiple ligament injury
• CT scan and X-rays are strongly recommended
in case of bony avulsion fracture of tibia.

23. Special test
1. Posterior drawer test
Patient is in supine lying
Procedure- 45 flexion at
hip & 90 flexion at knee
with feet on plinth.
Positive sign- posterior
drop of tibia

24. 2. Posterior sag test
Patient is in supine lying
Procedure- 45 flexion at
hip and 90 flexion on
knee with feet on
plinth
Positive sign- tibia drops
posteriorly

25. 3. Slocum test for anterolateral
rotatory instability
Patient is in supine lying
Procedure- 45 flexion at hip and
90
flexion at knee, foot placed in
30 medial rotation and
stabilized, posteroanterior
force is applied on tibia.
positive sign- excessive
movement on lateral side,
when compared with other
knee.

26. 4. Abduction (valgus) stress test-
Test for full extension ligament injury
Patient is in supine lying
Procedure-ankle is stabilized and medial
pressure is applied on knee joint at 0 & then
at extension in 20-30
Positive sign- excessive movement is seen as
compared to opposite knee.

28. Treatment
• Surgery – arthroscopy in partial tear /
complete tear
• Open knee surgery in PCL injury with bony
avulsion.
• Knee braces

32. Complications
• Stiffness
• Long bed rest
• Bleeding
• Blood clots
• Swelling
• Re-construction surgery

33. Reference- B D Chaurasia’s human anatomy volume 2,chapter-
10,page no.137,edition sixth.
Orthopedic physical assessment, David J Magee, chapter-12, page
no-765, edition sixth
The pocket book for physiotherapy, Gitesh Amrohit, edition 2th.
Textbook of biomachanics, Prof.(Dr.) Shyamal Koley, chapter-13,
knee complex biomachanics, page no-203-223, Aitbs books.
Joint structure& function, Cynthia C. Norkin, fifth edition,
biomacahnics of knee complex.
S. Brent Brotzman, MD, posterior curciate liagment injuries, page no- 359-
700, chapter-5 posterior curciate ligment injuries.

34. Thank you
Happy Reading