Knee > PCL Tear > Treatments

   Ligament Reconstruction

Preparing for Surgery

If you and your physician have decided on reconstruction surgery to repair your torn PCL (posterior cruciate ligament), you will need to prepare for arthroscopic surgery. The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

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At most medical centers, you will go to "patient admissions" to check in for PCL reconstruction surgery. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your doctor. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Arrange for someone to drive you home when you are released. You may be released the same day, or may be required to stay overnight.

   Wear a loose pair of shorts or sweat pants with a zipper or buttons on the side that will fit comfortably over a knee brace when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

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The PCL (posterior cruciate ligament) is rebuilt using a graft from either your patellar tendon or from the patellar tendon of a cadaver. The patellar tendon is a ligament that connects your kneecap (patella) to your shinbone (tibia). The operation typically takes two to two-and-a-half hours.

   General anesthesia is typically used for surgery, though in some cases a spinal or epidural anesthetic is used. The anesthesiologist will administer the anesthesia once you are in the operating room.

   The surgeon makes an incision between two and three inches long and a graft, called an autograft, is taken from the middle portion of the patellar tendon, which is the ligament that connects the kneecap to the lower leg bone. A small piece of bone remains attached to the tendon on either side, and is removed with the graft.

   If a tendon from a cadaver (called an allograft) is used, there will be no need to make incisions to remove a graft from your leg.

   Your surgeon may need to make a small incision in the back of your knee to facilitate placement of the PCL graft.

   The surgeon uses an arthroscope to see inside the knee and small instruments to help with the reconstruction of the PCL. The graft, which will become the new PCL, is attached to the upper leg bone (femur) and the lower leg bone (tibia).

   Screws are put in place to hold the tendon in place until it becomes permanently attached to the bone. There is usually no need to remove the screws.

   Incisions are sewn up and the patient is taken to the recovery room.

Following PCL reconstruction surgery, you usually stay in the recovery room for at least two hours while the anesthetic wears off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. Your knee will be bandaged and may have ice on it. You may have significant pain early on and you should take pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present. When you feel the pain coming on, take another pill. You are safe as long as it is within the time limit on the bottle. You should try to move your feet while you are in the recovery room to improve circulation. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. It is likely that you will be able to bear some weight on your leg, but your surgeon may suggest that you use crutches or a cane for a couple of days. For most people, crutches are used only until you feel steady on your feet. Depending on your insurance, your surgeons preference, and your post-operative condition, you may stay overnight in the hospital. Some patients are discharged home from the recovery room. Arrange a ride home for when you are discharged.

Post-op in Hospital

Some patients remain in the hospital for as long as 24 hours after PCL reconstruction surgery. As soon as possible after surgery is completed, you will begin doing continuous passive motion exercises while in bed. Your leg will be flexed and extended to keep the knee joint from becoming stiff. This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion. There will likely be pain and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice helps control pain and swelling. A therapist may help you put on a PCL brace if it is prescribed by your physician, and to see that you can get around on crutches.

Your rehabilitation program begins the moment you wake up in the recovery room and continues at home, to restore strength and range of motion to your knee. Here is what you can expect and how you can cope during the first days after PCL reconstruction surgery:

   You will likely feel pain or discomfort for the first few days. Take pain medications as your doctor advises. These could be over-the-counter painkillers, such as aspirin or ibuprofen, or stronger narcotic drugs.

   Ask your physician when it is safe to take a shower.

   As much as possible, keep your knee elevated above heart level to reduce swelling and pain. Icing your knee for 20 or 30 minutes a few times a day during the first two days after surgery also will reduce pain.

   The dressing on your knee is usually removed the day after surgery. There may be some minor drainage for two days. Sterile dressings or bandages may be used during this time.

   In the first week after surgery, most patients are encouraged to lift their leg without assistance while lying on their back. These are called straight leg raises. By the end of the second week, they normally are able to walk without crutches.

   As soon as possible after surgery, you should begin doing exercises using a continuous passive motion (CPM) machine while in bed. Your doctor can arrange to get you a CPM machine, which helps flex and extend the leg and prevents the joint from becoming stiff due to inactivity.

   Some people may experience fever of up to 101 degrees during the first few days after surgery. This is usually nothing to worry about. See your doctor if you have any fever after three or four days that is accompanied by redness around your wound.

PAIN

A small amount of pain is normal during physical activity, but if you feel so much pain in your knee to warrant taking a painkiller before an activity, you should consider cutting back or stopping. Do not play through the pain after a PCL injury ­ it may be a sign that your activity is putting too much stress on your knee.

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Once the pain and swelling associated with your torn PCL (posterior cruciate ligament) have subsided, you should be ready to begin physical therapy aimed at strengthening the thigh (quadriceps) muscles and restoring your knee's range of motion. Everyone's rate of recovery is different, but recovery from a PCL reconstruction generally takes between three and six months. Range of motion is extremely important. Movement may be painful at first, but it is important to not allow the knee to stiffen. During the first week, you can expect to do exercises to strengthen the thigh muscles and regain range of motion in the knee. After that, you will progress to exercises that involve placing more weight on your leg, to increase strength and endurance. Eventually you will do exercises such as leg presses, stair climbing, and squats, all of which are designed to give you additional strength and control of your knee while increasing movement and resistance. Your therapist and physician will determine when it is safe to return to sports. You should be able to:

   Flex and extend your knee without pain

   Experience no swelling

   Feel as if your injured knee is as strong as your other knee

   Jog and sprint without limping

   Stop and cut while running without pain.

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Strengthening the thigh muscles may help prevent further knee injury. After up to six months of rehab, your knee may feel strong but your PCL may not stabilize your knee as well as it did before the injury. Remember that many of the exercises and activities that are popular for fitness put stress on your knees.

BRACES

There is no evidence that braces prevent ligament injury. Consult your physician if you are interested in wearing a brace for comfort.