PCL injuries damage the posterior cruciate ligament, a thick band at the knee's back that holds the shinbone steady against the thighbone.

These tears happen from high-impact forces, disrupting stability and leading to pain or looseness.

Dashboard Impact Mechanism

Car accidents top the list, with knees slamming into dashboards during frontal collisions. The bent knee flexes sharply as the shin drives backward, stretching the ligament beyond limits. Motorcycle wrecks follow closely, where sudden stops propel the lower leg rearward with foot planted. This direct anterior force on the upper shin tears fibers instantly, often with a pop sensation. Studies pinpoint these as 45 percent of cases, peaking in young adults.

Sports Collision Forces

Football tackles deliver blows to the front knee while flexed, mimicking crash dynamics. Skiers landing flexed with foot downward endure similar posterior shifts. Soccer players twisting mid-air or hyperextending on pivots overload the structure. Baseball slides or rugby scrums add rotational stress, combining extension with side loads. These contact scenarios account for 40 percent of tears, favoring males in high-speed pursuits.

​

Fall and Twist Scenarios

Forward falls onto a bent knee with pointed-down foot compress the ligament against the thighbone edge. Gymnastics dismounts or stair missteps create hyperextension, pulling tissues taut. Varus or valgus angles during quick direction changes amplify damage in runners or tennis athletes. Less common isolated twists occur in missteps, but power multiplies risk. Epidemiology shows average injury age at 27, with sports edging out vehicles slightly.

Dr. Gregory D. Schroeder, an orthopedic surgeon at Rush University Medical Center, explains that the posterior cruciate ligament is one of the knee’s main ligaments and plays a key role in keeping the shinbone from shifting backward under the thighbone, helping maintain knee stability.

Initial Rest and Ice Protocol

Treatment starts with RICE: rest avoids weight-bearing, ice reduces swelling for 20 minutes hourly, compression wraps stabilize, elevation above heart level drains fluid. Crutches aid mobility for grade 1 sprains, healing in weeks. Bracing limits motion, promoting natural fiber mend without surgery. Pain eases in days, strength returns gradually.

Physical Therapy Strengthening

Rehab focuses on quadriceps sets, straight-leg raises, and hamstring curls to balance muscles around the joint. Closed-chain exercises like mini-squats build control without shear. Proprioception drills on wobble boards retrain stability post-immobility. Progress spans 4-6 weeks for partial tears, restoring 90 percent function non-operatively. Compliance halves re-injury odds.

Bracing and Activity Modification

Custom PCL braces with dynamic hinges counter posterior sag during strides. Low-impact cross-training like swimming preserves fitness sans stress. Gradual return-to-sport protocols test laxity via hop tests. Grade 2 injuries thrive here, avoiding knives in 80 percent of athletes. Monitoring prevents arthritis creep from imbalance.

Surgical Reconstruction Options

Grade 3 full tears demand grafts from hamstring or patellar tendon, drilled through tunnels to mimic original path. Arthroscopic techniques minimize cuts, with rehab mirroring conservative paths but extended to months. Allograft choices speed recovery for older cases. Success rates hit 95 percent stability, ideal for elite demands.

PCL injuries arise from crashes, sports blows, falls, and twists, treated via rest, therapy, bracing, or surgery based on severity. Early intervention preserves motion and power effectively. Structured recovery ensures lasting knee resilience across activities.