PCL Avulsion Injuries Non-Surgical Treatment

Initially following the injury, it’s essential to rest the knee and avoid activities that worsen the pain or lead to episodes of instability. Repetitive episodes of instability can lead to further damage of other structures of the knee joint, including the cartilage of the patellofemoral joint (under the kneecap). Therefore, activities that include pivoting, lateral movement, cutting, jumping, or quick deceleration from running may need to be avoided following a PCL injury in order to avoid instability episodes.

Oral anti-inflammatory and pain-relieving medications, such as Meloxicam, Naproxen, Advil, or Ibuprofen, may help to manage the pain and reduce inflammation of the knee following a PCL injury. Applying ice packs and compression to the knee can also help reduce swelling and inflammation. Remember to use a cloth or towel between the ice pack and your skin to avoid frostbite.

A structured physical therapy program can be beneficial for strengthening the muscles around the knee and improving overall joint stability. However, physical therapy for a posterior cruciate ligament injury is somewhat more restrictive than for an ACL injury, as higher degrees of knee flexion can stress the PCL. Therefore, the physical therapy following a PCL injury should be focused on quadriceps muscle activation while avoiding hamstring activation. Too much activity from the hamstrings will pull the tibia backwards, which can stretch the healing of the PCL. It is important to complete any home exercises that your physical therapist provides to you in order to optimize your recovery.

Proprioceptive training can enhance knee stability. Proprioception is the body’s ability to sense joint position and movement, and improved proprioception can help with knee stability and control during activities.

A functional posterior cruciate ligament (PCL) brace is a specialized dynamic knee brace designed to provide support and stability to the knee joint in cases of PCL injuries or instability. Recall that a higher degree of knee flexion and hamstring activation will pull the tibia backwards, which can stretch the healing of the PCL. For this reason, a brace is usually needed to avoid PCL instability episodes. It is important for the patient to understand this reason for wearing the brace.

While a functional brace cannot fully replace the role of the PCL, it can help limit certain movements that could put additional stress on the knee and reduce the risk of further injury during physical activities. Here’s how a functional PCL brace works:

• Mechanical Support: The brace provides mechanical support to the knee by limiting excessive movements, such as backward sliding of the tibia relative to the femur. Recall, that this is the primary function of the PCL.
• Stabilization: The functional brace helps stabilize the knee joint. The brace typically exerts posterior pressure on the tibia, pushing it forward slightly to mimic the role of the intact PCL in preventing excessive backward movement of the tibia. This helps protect the PCL from further strain while promoting healing.
• Protection: A functional PCL brace is particularly useful for providing support during physical activities and sports that involve jumping, running, or sudden changes in direction. By applying the posterior pressure to avoid the tibia from sliding backwards, the PCL brace can help reduce the risk of further injury and provide confidence to the wearer.