What is the PCL?

The Posterior Cruciate Ligament (PCL) is one of the four main ligaments in the knee, located at the back of the joint. It prevents the shinbone (tibia) from moving too far backwards under the thighbone (femur). Although less commonly injured than the ACL, PCL tears can significantly affect stability and function.

What happens when you tear the PCL?

A PCL tear often occurs due to a direct blow to the front of the shin while the knee is bent, such as during a car accident (dashboard injury) or a fall in sports. Tears may be partial or complete, and they sometimes occur in conjunction with other ligament injuries.

Common causes

  • Dashboard injuries in car accidents
  • Falling on a bent knee
  • Sports collisions (rugby, football, basketball)
  • Hyperflexion of the knee
  • Severe twisting injuries

Who is most affected?

  • Contact athletes (rugby, football, basketball)
  • Motor vehicle accident victims
  • Less common in females compared to ACL tears
  • Typically, adults aged 18–45 are due to high activity levels

Symptoms of a PCL tear

  • Pain in the back of the knee
  • Swelling (often mild compared to ACL)
  • Difficulty walking, especially downhill or downstairs
  • Feeling of instability or the knee “giving way”

Diagnosis of PCL tears

Clinical Tests

  • Posterior drawer test
  • Quadriceps active test
  • Posterior sag sign

Imaging

  • X-rays: To rule out fractures or avulsion injuries
  • MRI (gold standard): Confirms partial vs complete tear, associated damage
  • In Australia, MRI scans are often bulk-billed if under 50 years of age

Treatment Options

Management depends on severity, lifestyle, and patient goals. Shared decision-making is essential.

Non-surgical

  • PEACE & LOVE principles for acute injury care
  • Bracing to limit the backward movement of the tibia
  • Physiotherapy for strengthening and stability
  • Important: Most isolated PCL injuries do not require surgery. Many patients recover well with structured rehabilitation.

Surgical

  • PCL reconstruction surgery for severe instability or multi-ligament injury
  • Less common than ACL surgery, but sometimes necessary in athletes

Role of physiotherapy

  • Quadriceps strengthening (to compensate for posterior laxity)
  • Proprioception and balance retraining
  • Sport-specific drills for safe return to play
  • Gradual loading program

Recovery timeline

  • Non-surgical: 3–6 months for functional recovery
  • Surgical: 9–12 months for return to sport

Injury grading

  • Grade I (mild sprain): Microscopic tearing of PCL fibres. The knee remains stable, but pain and swelling may still be present.
  • Grade II (partial tear): More fibres torn, leading to mild to moderate instability. Often causes difficulty with downhill walking or descending stairs.
  • Grade III (complete tear): The Entire ligament is ruptured. Significant posterior instability, often with associated ligament injuries.

Prevention of PCL injuries

  • Strengthening quads and hamstrings
  • Technique training for landing and contact
  • Sport-specific prevention programs

Taping and bracing

  • PCL-specific braces can reduce posterior tibial translation during the early stages of healing.
  • Rigid taping techniques can provide short-term support, particularly in sport.

When to see a physiotherapist or chiropractor

📞 If you’ve had trauma to your knee, swelling, or persistent instability, book an assessment at Spinal and Sports Care (Bella Vista or Parramatta).

Frequently Asked Questions

PCL injuries represent around 3–5% of major knee ligament injuries. They are less frequent than ACL tears but more common in motor vehicle accidents than in sports.

Rugby, AFL, and football are higher-risk in Australia due to collisions and falls onto bent knees.

Yes. Many isolated Grade I–II tears do well with physiotherapy and bracing. Most PCL injuries never progress to surgery.

Isolated PCL tears have lower re-injury rates compared to ACL tears. However, combined PCL/PLC tears have a higher risk of chronic instability.