Treatment / Knee / PCL Reconstruction

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KNEE | LAS VEGAS

PCL Reconstruction

Dr. Andrew Lee, MD | Nevada Spine Clinic, Las Vegas, Nevada

Understanding the PCL

The posterior cruciate ligament is the strongest ligament in the knee, running from the posterior tibia to the anterior femur. It prevents the tibia from sliding backward beneath the femur and contributes to rotational stability.


PCL tears are less common than ACL tears and more often result from direct trauma such as a dashboard injury in a motor vehicle accident or a fall on a flexed knee. Many isolated PCL tears are managed non-operatively, with surgery reserved for cases causing significant functional instability.

PCL Tear Symptoms and Indications for Surgery

  • Complete PCL Tear: Full disruption causing posterior knee instability, pain, and functional limitation.
  • Combined Ligament Injuries: PCL tears occurring with concurrent ACL, posterolateral corner, or medial-sided injuries require surgical reconstruction for adequate stability.
  • Functional Instability: Persistent giving way or inability to return to desired activity despite rehabilitation.
  • Chronic PCL Deficiency: Progressive articular cartilage damage from long-standing posterior instability. 

Conservative Non-Surgical Care

Many isolated PCL tears can be managed non-operatively with physical therapy focused on quadriceps strengthening, which compensates for PCL deficiency. Dr. Andrew Lee at Nevada Spine Clinic in Las Vegas evaluates each PCL injury carefully before
recommending surgical reconstruction.

Surgery is recommended for combined ligament injuries, grade three PCL tears causing significant instability, and chronic PCL deficiency causing functional limitation despite rehabilitation.

PCL Reconstruction

PCL reconstruction replaces the torn ligament with graft tissue to restore posterior tibial stability. Dr. Andrew Lee performs PCL reconstruction arthroscopically at Southern Hills Hospital in Las Vegas, using techniques that minimize the neurovascular risk associated with posterior tibial tunnel drilling.

Similar to ACL reconstruction, bone tunnels are drilled at the native PCL attachment sites and graft tissue is passed and secured with fixation devices. The PCL reconstruction is technically more demanding than ACL reconstruction due to the proximity of neurovascular structures at the posterior tibial attachment site.

Concurrent posterolateral corner or medial-sided injuries are addressed at the time of PCL reconstruction to achieve complete multiligament stability.

The primary goals of this procedure are to:
  • Restore posterior tibial stability to the knee
  • Address concurrent ligament injuries comprehensively
  • Allow return to high-demand activity
  • Prevent progressive cartilage damage from chronic instability

Potential Risks

  • Neurovascular injury: The popliteal vessels and tibial nerve are at risk during posterior tibial tunnel drilling.
  • Graft failure: Less common than ACL re-tear but possible.
  • Stiffness: Post-operative knee stiffness can limit functional recovery.
  • Infection: Preventive antibiotics are given.
  • Tunnel malposition: Critical for reproducing native PCL biomechanics.

Postoperative Recovery and Rehabilitation

Rehabilitation following PCL reconstruction requires a careful progressive approach. Protected weight bearing with the knee in extension prevents posterior tibial sag that could stress the reconstruction during early healing.

Return to sport following PCL reconstruction typically requires nine to twelve months of structured rehabilitation.

What to Expect After Surgery

Posterior knee stability improves progressively with rehabilitation following PCL reconstruction. Most patients achieve functional stability by six months with continued improvement through one year.

Outcomes following PCL reconstruction for combined multiligament injuries are highly dependent on complete rehabilitation of all reconstructed structures.

Do not soak your wound.

No bathtub, swimming, or hot tub until cleared by Dr. Lee.

Wound Care and Medication Management

Follow wound care instructions provided at discharge. Keep incisions dry until cleared by Dr. Lee.

Take all prescribed medications as directed. Contact your pharmacy forty-eight hours in advance for any refills.

Activity Guidelines After Surgery

Follow the specific weight bearing and brace instructions provided for PCL reconstruction. Return to sport requires Dr. Lee’s clearance based on functional testing.

Contact Nevada Spine Clinic or go to the emergency room for sudden knee swelling, fever, or wound changes.

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No bathtub, swimming, or hot tub until cleared by Dr. Lee.

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Dr. Andrew Lee, MD | Nevada Spine Clinic, Las Vegas

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