Tear > Treatments
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.
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
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.
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.
possible, practice walking with your crutches in case
you need to use them after surgery.
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.
to ask the doctor
to take to the hospital
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:
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
for someone to drive you home when you are released.
You may be released the same day, or may be required
to stay overnight.
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.
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.
to take to the hospital
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.
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.
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.
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.
surgeon may need to make a small incision in the back
of your knee to facilitate placement of the PCL graft.
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).
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.
are sewn up and the patient is taken to the recovery
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
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
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.
your physician when it is safe to take a shower.
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.
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
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.
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.
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.
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.
to call the doctor after surgery
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:
and extend your knee without pain
as if your injured knee is as strong as your other knee
and sprint without limping
and cut while running without pain.
strengthening exercises: Ligament injuries
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.
There is no evidence that braces prevent ligament injury.
Consult your physician if you are interested in wearing
a brace for comfort.