Pcl pp

pcl

1. PCL Posterior cruciate ligament Dr. Dhruv Taneja M.P.T, MIAP Assistant Professor

2. PCL with functions The posterior cruciate ligament (or PCL) is one of the four major ligaments of the knee. It connects the  posterior intercondylar area of the  tibia  to the medial condyle of the femur. The PCL is a strong fan shaped and intracapsular ligament along with the  anterior cruciate ligament(ACL). They are both isolated from the fluid-filled synovial cavity, with the synovial membrane wrapped around them. It has two parts Anterolateral posteromedial

3. Function of PCL The function of the PCL is to prevent the femur from sliding off the anterior edge of the tibia. Prevents hyperflexion of the knee to a lessor extent with ACL but its main function is to check extension and hyperextension. It also helps in checking the rotational movements with ACL. To prevent the tibia from displacing posterior to the femur .*****

4. MECHANISM OF INJURY DIRECT BLOW TO THE KNEE WHILE IT IS FLEXED(dashboard injury) FALLING HARD ON THE KNEE Hyperextension injury (any mechanism that involves the knee to be forced posteriorly can leads to pcl injury).

5. Classification Classification based on posterior subluxation of tibia relative to femoral condyles (with knee in 90° of flexion) Grade I ( partial) 1-5 mm  posterior tibial translation tibia remains anterior to the femoral condyles Grade II (complete isolated) 6-10 mm  posterior tibial translation complete injury in which the anterior tibia is flush with the femoral condyles Grade III (combined PCL and capsuloligamentous ) >10 mm  posterior tibial translation tibia is posterior to the femoral condyles and often indicates an associated ACL and/or PLC injury

6. Diagnosis History Special tests (please name it ) M.R.I/C.T scan Note:- whoever will name the special tests has to explain it

7. Special tests Posterior drawers test*** Reverse lachmans test* Godfreys test

8. Post. drawers test

9. Reverse lachmans test

10. Godfreys test

11. Treatment Complete rest Surgical intervention Physiotherapy rehabilitaion

12. Rest Complete rest is advised within a supportive brace for grade 1 and grade 2 tear of PCL, which generally heals on its own. Surgery :- Surgery is performed for grade 3 and grade 4 tearing. Graft is taken from either hamstrings or achilles tendon. Ligament reconstruction arthroscopy is performed.

13. Rehabilitation Acute stage(the aim of acute stage stage Rx is to control pain and inflammation). PRICE Ankle toe movements Quadriceps sets at the earliest. Cryotherapy - ice packs for 15 mins every hour. U.S. IFT TENS (PRECAUTION:- Protect the knee from posterior or extension stresses).

14. Subacute stage SLR QUADRICEDPS SETS SELF ASSISSTED KNEE ROM EXERCISES HAMSTRINGS SETS DELORME,S EXS

15. CHRONIC STAGE Focus on quadriceps and hamstrings sets as they are the one which will be giving trouble to the patient. Focus on hip flexors and extensors aswell .

16. Leg lifts in standing with brace on for balance and hip strength Progression criteria Patient may progress to Phase II if they have met the above stated goals and have • Pain free gait using brace without crutches, • No effusion • Knee flexion to 90°

17. Progression criteria • Patient may progress to Phase III if they have met the above stated goals and have • Normal gait on all surfaces • Ability to carry out functional movements without unloading affected leg and without pain, while demonstrating good control • Single-leg balance greater than 15 seconds • Full range of motion.

18. Progression criteria • Patient may progress to Phase IV if they have met the above stated goals and have • Normal gait on all surfaces • Ability to carry out multi-plane functional movements with out unloading affected leg or pain, while demonstrating good control • Ability to land from a sagittal, frontal and transverse plane leap with good control and balance

19. Return to sport/work criteria Dynamic neuromuscular control with multi-plane activities, without instability, pain or swelling