Ever heard of the ruckman’s curse? Though it sounds like yet another Pirates of the Caribbean film, it actually refers to posterior cruciate ligament (PCL) injuries, which AFL ruckmen were particularly vulnerable to, at least before the centre circle rule was introduced.
Aussie Rules is an exciting, tough and fast-paced game. Two opposing ruckmen race towards each other and then leap into the air to contest a ball in flight. From there, it’s all too easy to collide at speed with the knee flexed or to land heavily on a flexed knee – and that’s often how PCL injuries occur.
What is the posterior cruciate ligament (PCL)?
The PCL is one of several ligaments that connect your thigh bone (femur) to your tibia (shin bone). It’s a large, thick ligament that sits at the back of your knee joint. The PCL keeps your knee in place and helps it move smoothly.
What causes posterior cruciate ligament PCL tear?
Because the PCL is strong and well-protected, it takes a lot to injure it. A PCL injury may happen when a bent knee is subjected to great force during events such as a:
- Fall or collision in sports such as AFL, rugby, soccer or netball
- Motorbike accident
- Car crash.
Some people injure their PCL while the rest of their knee remains intact. Others experience a PCL injury as part of a multi-ligament knee injury.
Symptoms of a PCL injury
If you’ve injured your PCL, you may:
- Be in mild to severe pain that tends to worsen over time
- Have an unstable, swollen or stiff knee
- Be reluctant to put your full weight on the knee
- Find it hard to walk or go down the stairs
- Not be able to take part in your chosen sport.
How is it diagnosed?
PCL injuries can be quite hard to diagnose as clinical findings can be subtle rather than obvious.
Diagnosing a PCL injury may involve:
- Assessing your medical history – has there been a history of recent knee trauma where the knee has swollen and given way?
- A clinical examination of your knee – the injured knee may appear to sag backwards when it’s bent or it may over-extend
- An MRI scan – this usually confirms the diagnosis, though occasionally the injured knee still looks normal on MRI, especially if the injury occurred some time ago.
What treatment options are available?
The right treatment depends on how severely your PCL is injured. The treatment ladder may include options such as:
- Crutches to ease the load on your knee for a bit
- A knee brace to provide stability to your knee
- Physiotherapy to strengthen and stabilise your knee
- Surgery to reconstruct your PCL.
When does a PCL tear require surgery?
A torn PCL may require surgical repair if the injury is severe or associated with significant knee laxity.
In some cases, you may be able to try conservative treatment first and only need to consider surgery if physiotherapy doesn’t succeed.
However, if you’ve sustained a PCL injury as part of a multi-ligament knee injury, then surgery may be the best treatment choice from the outset.
Directly repairing the PCL isn’t always possible. Often, we reconstruct it using a tendon graft. Options include:
- Autograft – we use part of your own hamstring, quadriceps or patella tendon
- Allograft – donor tissue.
After surgery, you’ll be enrolled in a rehabilitation program. Full recovery may take 6-12 months depending on the nature of your injury.
How can I help?
If you’re concerned about your knee, please come to see me. PCL injuries can be complex and require treatment tailored to your unique situation.
I am an orthopaedic surgeon with extended expertise in all aspects of knee surgery including PCL injuries and complex multi-ligament injuries. I perform PCL reconstruction as an arthroscopic (keyhole) procedure, which is minimally invasive.
Please make an appointment today.
Disclaimer
All information is general and is not intended to be a substitute for professional medical advice. Any surgical or invasive procedure carries risks. Dr Ross Radic can consult with you to determine if a particular treatment or procedure is right for you. A second opinion may help you decide on your options.
References
- Saw R, Finch CF, Samra D, Baquie P, Cardoso T, Hope D, Orchard JW. Injuries in Australian Rules Football: An Overview of Injury Rates, Patterns, and Mechanisms Across All Levels of Play. Sports Health. 2018 May/Jun;10(3):208-216. doi: 10.1177/1941738117726070. Epub 2017 Aug 21. PMID: 28825878; PMCID: PMC5958447. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958447/, [Accessed 8 February 2024]
- Cleveland Clinic, Posterior cruciate ligament injury, https://my.clevelandclinic.org/health/diseases/21793-pcl-posterior-cruciate-ligament-tears, [Accessed 8 February 2024]
