PCL Reconstruction Surgery in Delhi
PCL Reconstruction- Posterior Cruciate Ligament
What is PCL injury?
The PCL, one of the key ligaments in the knee joint, plays a crucial role in stabilizing the tibia (leg bone) on the femur (thigh bone). It originates from the lateral side of the medial condyle of the femur and attaches to the back of the tibial plateau. Its primary function is to prevent backward movement of the tibia relative to the femur, as well as to withstand varus, valgus, and external rotation forces. The PCL is thicker and stronger than the ACL, making it less susceptible to injury. Compared to ACL injuries, PCL injuries are less frequent, with an incidence ranging from 3 to 40 in Indian populations. Males are more likely than females to experience PCL injuries at a ratio of 2:1. PCL tears commonly occur alongside other ligament injuries; isolated PCL tears are uncommon occurrences.
How does PCL injury occur?
The PCL can be injured by strong forces pushing the proximal tibia of a bent knee forward, such as in dashboard injuries or falling onto a bent knee. Common sports associated with PCL injuries include football, skiing, soccer, and baseball. Less frequently, the PCL can be damaged during rotational hyperextension of the knee. Research from 2003 identified car accidents and sports as the main causes of PCL injuries. Dashboard injuries and falls onto a flexed knee with the foot pointed down are the most common ways the PCL gets injured. Athletes often experience isolated PCL injuries due to excessive bending of the knee. Injuries can also occur from landing poorly after a jump or making sudden movements in different directions.
What are types or grades of PCL injury?
PCL injury may present with different grades or severity.
Grade – 1 : mild sprain in which knee is stable and function will be normal
Grade – 2 : partial tear , there will be feeling of instability
Grade – 3 : complete tear or sometimes there will be bony avulsion from tibia from insertion point in which patient feeling unstable of knee and unable to bear weight or walk.
What are symptoms & signs of PCL injury?
Severe trauma can lead to PCL injuries. Patients typically experience sudden pain, swelling, and instability. It is important to gather a comprehensive history, including details about motor vehicle accidents and dashboard injuries where the knee was fully flexed. Some patients may hear a popping sound similar to an ACL injury, while others may not. In acute cases, there may be instability but the patient can still walk and bear weight. Chronic PCL tears may cause discomfort, instability, and pain at the back of the knee when bearing weight with a slightly bent knee position (such as climbing stairs or squatting).
How to diagnose PCL injury?
The orthopedic doctor will conduct a thorough examination of the patient, including physical and clinical tests such as the posterior drawer test, posterior Lachman test, posterior sag test, and other relevant tests to identify PCL tears. Diagnostic procedures like X-rays will be performed to rule out fractures or avulsions, with a CT scan ordered if necessary. However, MRI remains the primary diagnostic tool for confirming ligamentous injuries and providing a more precise assessment of the injury. X-rays will include various views of the knee to assess for any associated fractures or bony involvement. MRI is considered the gold standard for evaluating PCL injuries and can also detect other ligament or meniscus injuries.
What is the treatment of PCL tear?
The main factor to consider the treatment of PCL tear depends on weather it is acute or chronic, any associated injury, any bony avulsion of PCL, weather any displacement of bony fracture. Non operative treatment is primary for PCL tears in type 1&2 in acute injury, there is good outcomes and return to sports. Conservative line of treatment includes ICE PACKS, REST, BRACE, NSAIDs, Immobilisation for 3 – 4 weeks, physiotherapy followed in acute injury. In type 3 also conservative can be done but chances of instability are more and healing will be less, can be managed conservative by brace with long term. Surgical indication for PCL is in acute injury if tibial translation is more than 12 mm, instability, bony avulsion with displacement more than 4 mm, associated injury of knee menisci, other ligament injury, chronic PCL tear. Surgical options can be by arthroscopic repair of PCL in avulsion cases, reconstruction with graft with hamstrings or quadriceps, open technique can also be done in case of avulsion injury of PCL tear followed by physiotherapy should be done for good outcomes and return to sports will be in 8 – 9 months.
The appropriate treatment for a PCL tear depends on whether it is acute or chronic, any associated injuries, the presence of a bony avulsion of the PCL, and any displacement of a bony fracture.
Non-surgical methods are typically preferred for type 1 and 2 PCL tears in acute injuries, with favorable outcomes and a return to sports possible. Conservative treatment may involve the use of ice packs, rest, braces, NSAIDs, immobilization for 3 to 4 weeks, and subsequent physiotherapy in acute cases. Type 3 tears can also be managed conservatively but may result in increased instability and reduced healing; long-term bracing may be necessary.
Surgical intervention is indicated in cases of acute injury with significant tibial translation (>12 mm), instability, bony avulsion with displacement exceeding 4 mm, associated knee injuries such as meniscus or other ligament damage, or chronic PCL tears. Surgical options include arthroscopic repair for avulsion cases or reconstruction using grafts from hamstrings or quadriceps muscles. Open techniques may also be utilized for avulsion injuries followed by post-operative physiotherapy to facilitate recovery; return to sports activities can occur within 8 to 9 months post-surgery.
PCL reconstruction surgery is a crucial procedure for individuals dealing with knee stability issues and experiencing chronic pain due to PCL injury. If you are looking for the best PCL Reconstruction Surgeon in Delhi, look no further than our Dr. Vishwadeep Sharma. Dr. Vishwadeep Sharma stands out as a beacon of excellence and expertise. With years of specialized training and experience in knee surgery, Dr. Sharma has earned a reputation for his precision and skill in performing PCL reconstruction surgeries. Patients trust him not only for his technical proficiency but also for his compassionate approach to patient care.
Dr. Vishwadeep Sharma's commitment to staying at the forefront of advancements in orthopedic surgery ensures that his patients receive the most innovative treatments available. His dedication to achieving optimal outcomes for every patient sets him apart as a top choice for PCL reconstruction surgery in Delhi. With Dr. Sharma, patients can rest assured that they are in capable hands, receiving personalized care tailored to their unique needs and circumstances.