1. Background

Intact PCL





2 x as strong as ACL

About the same length as ACL 38 mm


Cross sectional area 150% of ACL

13 mm diameter (thicker) 


2 Bundles


1.  Anterolateral

- most important

- double the size of the posteromedial

- tight in flexion

- try to reconstruct this bundle


2.  Posteromedial

- tight in extension


Femoral insertion


Half moon

- anterolateral aspect MFC

- much more anterior than the origin of ACL                                                                                                       

- inserts 5mm posterior to articular margin on MFC 

- midpoint is 1 cm posterior                                                                                                                   

- 1 or 11 o'clock


PCL Arthroscopy


Radiographic anatomy of femoral PCL insertion



Tibial insertion 


PCL facet

- 1 cm below joint line


Radiographic anatomy of the tibial insertion of PCL insertion



Menisco-femoral ligaments


Both insert onto femur with PCL

Originate from posterior horn lateral meniscus

At least one present in > half of all knees



- <1/3 diameter of PCL

- anterior


LIgament Wrisberg


Wrisberg Ligament

- 1/2 diameter of PCL        

- posterior to PCL                                                                                                                                                                                                                                                                                                                 

Arterial supply


Middle genicular artery


Nerve Supply


Tibial nerve




Primary restraint to posterior tibial translation

- secondary restraints are posterolateral corner

- posterior translation increased even further if PLC and PCL sectioned


Secondary restraint to ER and varus



10x less common ACL




Direct trauma

- posteriorly directed force on flexed knee

- dashboard injury



- forced knee hyper-extension


Associated Injuries


Multi-ligament knee injury

- posterolateral corner

- posteromedial corner





Injury often unremarkable

- knee doesn't feel right

- don't feel pop or tear

- posterior knee pain


May complain of difficulties walking down stairs in chronic situation




Excessive Recurvatum


PCL Deficient Recurvatum


Positive Lachman's


Will be positive with both ACL and PCL


Posterior Sag

- place knee at 90 degrees

- tibia will sag posteriorly

- loss of tibial step off (N 1 cm)


PCL Posterior Sag


Posterior drawer


Restore step off first (tibia 1 cm anterior to femur) then push tibia back

- Grade 1 < 5mm

- Grade 2 < 10

- Grade 3 > 10


PCL Deficient Lachmans 2PCL Deficient Lachmans 1


Quadriceps Active Test

- patients contracts quadriceps with foot stabilised

- the tibia is reduced anteriorly from its subluxed position by the quadricepts


Exclude Associated Ligament injury


PLC instability


1.  Posterolateral draw with foot ER


2.  Dial test

- patient prone, external rotation

- > 10 - 15o  compared with other side abnormal

- asymmetry 30o posterolateral corner only

- asymmetry 30 and 90o, PCL and posterolateral corner


Dial Test




Bony Avulsion


PCL AvulsionPCL Bony AvulsionPCL bony avulsion


Posterior subluxation of tibia


PCL Deficient Knee Posterior Subluxation Tibia


Grade 3 PCL disruption

- posterior tibia subluxed behind posterior aspect femoral condyles




PCL completely torn

PCL completely torn


PCL Midsubstance tear with stretching

PCL midsubstance tear with lengthening


PCL Avulsion MRI

PCL tibial avulsion


PCL femoral avulsion MRI

PCL femoral avulsion




May miss tear as is extra-synovial


PCL Torn Arthroscopy 2PCL Tear Arthroscopy

Chronic PCL tear from femur


PCL femoral avulsion acutePCL femoral avulsion

Acute PCL femoral avulsion