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Toronto, AL M5N 2M7
Ph: 416-483-2654
Fax: 416-483-2654

Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I fell off the back of a haywagon this summer and landed on my knees. I felt a definite clunk on the left when I stood back up. The doctor I saw could take my lower leg and push it until it clunked again. I've been told this is a sign that my PCL is broken. Is surgery always needed for this problem?

At first, treatment for a PCL injury focuses on decreasing pain and swelling in the knee. Rest and mild pain medications, such as acetaminophen (Tylenol), can help decrease these symptoms. You may need to use a long-leg brace and crutches at first to limit pain. Most patients are given the okay to put a normal amount of weight down while walking. Less severe PCL tears are usually treated with a progressive rehabilitation program. Athletes involved in high-demand sports activities may require a special knee brace before returning to play. These braces are designed to replace knee stability when the PCL doesn't function properly. They help keep the knee from giving way during moderate activity. Most patients receive physical therapy treatments after a PCL injury. Therapists treat swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation. Exercises are used to help you regain normal movement of joints and muscles. Range-of-motion exercises should be started right away with the goal of helping you swiftly regain full movement in your knee. This includes the use of a stationary bike, gentle stretching, and careful pressure applied to the knee by the therapist. Exercises are also given to improve the strength of the quadriceps muscles on the front of the thigh. As your symptoms ease and strength improves, you will be guided in specialized exercises to improve knee stability. If the PCL alone is injured, nonsurgical treatment may be all that is necessary. When other structures in the knee are injured, patients generally do better having surgery within a few weeks after the injury. Long-term studies show that without reconstructive surgery, over time, knee instability and joint degeneration develop. The main goal of surgery is to keep the tibia from moving too far backwards under the femur and to get the knee functioning normally again. New studies also suggest the need to restore medial-lateral (side-to-side) and rotational stability, too. Most surgeons now favor reconstruction of the PCL using a piece of tendon or ligament to replace the torn PCL. It's important that the surgeon identify all areas of the joint that have been damaged. For example, PCL injuries are often accompanied by damage to the posterolateral corner. And studies show that repairing the PCL without fixing the corner results in a failed surgery. Posterior refers to the back side of the knee.Lateral is along the outside edge of the joint. There are five basic structures that make up the posterolateral corner. These include two muscles: the lateral head of the gastrocnemius (calf) and the popliteus. Three ligaments are also involved: the popliteofibular ligament, the lateral collateral ligament (LCL), and the arcuate-fabellofibular ligament complex. You will probably be involved in a progressive rehabilitation program for four to six months after surgery to ensure the best result from your PCL reconstruction. In the first six weeks following surgery, expect to see the physical therapist two to three times a week. If your surgery and rehabilitation go as planned, you may only need to do a home program and see your therapist every few weeks over the four to six month period.


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