ACL/PCL Reconstruction

Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament injuries are common in sports that involve jumping, pivoting, or twisting. This article discusses both ACL and PCL injuries. We will explore whether surgery is always necessary, what the procedure involves, and what to expect during recovery.

If you would like more information about how to treat an ACL or PCL injury effectively, contact Brotzman Sports Medicine in Austin, Texas, today!

S. Brent Brotzman, MD

Orthopedic & Sports Medicine Specialist located in Austin, TX

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Knee Cruciate Ligament Anatomy

The cruciate ligaments cross diagonally inside your knee joint to form an X. Anterior cruciate ligaments (ACL) are found in front of your knees, and the posterior cruciate ligaments (PCL) are found in the back. These ligaments control the front and back movements of your knee.

Anterior Cruciate Ligament Injuries

The ACL stops the tibia (shinbone) from sliding out in front of the femur (thigh bone) and stabilizes the knee. An injury to the ACL is one of the most common knee injuries. They often occur in sports that require pivoting or jumping, such as soccer, football, and basketball. ACL injuries usually require surgery to return to the previous activity level.

Posterior Cruciate Ligament Injuries

The PCL stops the tibia from sliding too far backward. The PCL is much stronger than the ACL and injuries occur less often. Injuries occur in high-impact accidents such as car accidents or falling on a bent knee. They may also occur in sports where impact is likely.

ACL Injury Symptoms

At the time of an ACL injury, you may hear a popping sound, and your knee will give out from under you. Other symptoms include the following:

  • Pain and swelling in your knee
  • Reduced range of motion
  • Discomfort walking
  • Tenderness in your knee joint

PCL Injury Symptoms

The symptoms of a PCL injury may include the following:

  • Pain with swelling that occurs steadily and quickly after the injury
  • Swelling that makes the knee stiff and may cause a limp
  • Difficulty walking
  • The knee feels unstable, like it may “give out”

Do Knee Ligament Injuries Always Require Surgery?

No, knee ligament injuries do not always require surgery. Surgery will depend on which ligament you injured and the desired outcome following recovery. Knee surgery is usually always required if you have damaged more than one structure in the knee, such as the meniscus or the lateral or medial collateral ligament.

You may require surgery for an ACL injury if:

  • You’re an adult who participates in sports involving turning and pivoting.
  • Your job involves manual work.
  • You’re a child or adolescent. This can help prevent future meniscus or cartilage injuries.
  • You have injured your menisci, articular cartilage, collateral ligaments, joint capsule, or a combination.

Many PCL injuries do not require surgery. However, you may require surgery if you have injured other ligaments at the same time. Even if you have an isolated PCL tear, you may benefit from reconstruction if you continue to have instability or pain after receiving non-surgical treatments.

ACL and PCL Reconstruction Procedure

Anterior cruciate ligament and posterior cruciate ligament reconstruction procedures can be done using a similar surgical technique. Your surgeon will operate using an arthroscope and tiny instruments through small incisions. The procedure generally follows these steps.

  1. Under anesthesia, your surgeon will examine your knee to determine the extent of damage and see if other ligaments are damaged.
  2. Then the ACL graft is prepared. They will either take one from another area of your body (autograft) or thaw out a donor graft (allograft). A patellar tendon graft is usually used as it is strong and has high success rates.
  3. Small incisions are made to allow access to the arthroscope, and tiny instruments are used to reconstruct the ligament.
  4. The torn ligament stump is removed and holes are drilled into the bones ready for ligament attachment.
  5. The graft is placed anatomically and secured with screws or buttons.
  6. Finally, the incisions are closed using sutures.

What Happens After Knee Surgery?

After surgery, experiencing some pain is a normal part of the healing process. Your medical team will work to alleviate your discomfort. You will likely be prescribed medications for short-term pain relief.

Risks of Ligament Reconstruction Surgery

The risks of ligament reconstruction surgery include the following:

  • Infection
  • Viral transmission
  • Bleeding, numbness
  • Blood clot
  • Instability
  • Stiffness
  • Extensor mechanism failure
  • Growth plate injury
  • Kneecap pain

Recovering from ACL and PCL Ligament Surgery

Recovery from ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) reconstruction surgeries requires diligence and patience. Physical therapy is integral to successful recovery, commencing immediately after surgery.

The initial stage of recovery involves looking after your wound. You will need to keep it clean and dry for 7 to 10 days after surgery. During this time, physical therapy will focus on knee flexion and quadriceps control. Your surgeon will determine when you can weight-bear on your leg.

Rehabilitation objectives for ACL reconstruction include the following:

  • Reducing knee swelling
  • Maintaining patellar mobility
  • Restoring full knee range of motion
  • Strengthening the quadriceps and hamstring muscles.

Return to sports is typically permitted when pain and swelling subside, full range of motion is achieved, muscle strength and functional leg use are restored, and neuromuscular control is optimized. Most patients resume sports activities within 6 to 12 months, guided by their progress and overall recovery.

Schedule an Appointment Today

For personalized care and expert advice on ACL and PCL injuries, schedule a consultation with Brotzman Sports Medicine in Austin, TX. Dr. Brotzman can guide you through treatment options and help you on the path to recovery.

Don’t let knee injuries hold you back from an active lifestyle. Take the first step towards recovery today!


Words from our patients