PCL Injuries
A PCL injury is a tear of the posterior cruciate ligament, a strong band of tissue at the back of the knee that connects your thighbone to your shinbone and helps keep your knee stable.
The PCL is one of four major ligaments in the knee, and while less commonly injured than the anterior cruciate ligament, or ACL, a PCL tear can significantly affect knee function and stability. Most PCL injuries occur from direct trauma to the front of the knee while the leg is bent, such as a dashboard injury in a car accident, a fall onto a bent knee, or hyperextension during sports. I also see PCL injuries in contact sports when athletes experience direct blows to the front of the knee, and occasionally as part of complex knee injuries involving multiple ligament tears.
The PCL is one of the most important stabilizers in your knee, acting as a dam to prevent your shinbone from sliding backward beneath your thighbone. When this ligament tears, patients typically feel pain, swelling, and a sensation of their knee giving way or sliding. In my practice at Proliance Orthopedic Associates, I evaluate each PCL injury carefully to determine whether conservative treatment or surgery is the right path forward.
Video Education
Dr. Merritt has filmed several in-depth videos on PCL Injuries with the aim of helping patients understand the condition, the procedure, and what to expect during recovery.
Treatment Options
The vast majority of PCL tears, particularly isolated partial tears or Grade I and II injuries, heal well with nonsurgical treatment. I start most patients with a period of bracing, ice, elevation, and physical therapy focused on quadriceps strengthening and hamstring stretching. The quadriceps muscle can take over some of the PCL’s stabilizing role, which is why strengthening it is central to conservative management. Many high level athletes have non-operatively treated PCL injuries and have returned to high-level sports, including the NFL. Christian McCaffrey is a common example.
However, I do recommend surgery for patients in some situations. Complete PCL tears with significant instability, injuries involving multiple ligaments, sometimes in young athletes in high-demand sports who fail conservative treatment, or those who develop chronic instability after months of conservative care. When surgery is indicated, I typically use an allograft, or cadaver graft, rather than harvesting your own tissue, as it avoids the additional injury to your thigh or hamstring that comes with autograft reconstruction. I place the graft through tibial and femoral tunnels to rebuild the PCL’s anatomy and restore knee stability. After surgery, the focus shifts immediately to protecting the healing graft while beginning early quadriceps activation and gentle range of motion work. The process is slower than ACL recovery because PCL grafts take longer to incorporate into bone, and aggressive hamstring work early on can stress the new ligament.
Recovery and Results
Nonsurgical PCL recovery typically takes four to six weeks before you can return to light activities, with full recovery often occurring by three to four months. For surgical PCL reconstruction, expect a longer timeline. In the first four to six weeks, you’ll wear a hinged knee brace, use crutches, and perform carefully controlled range of motion and quadriceps exercises. By week six to eight, most patients can begin removing the brace for therapy sessions and work toward full range of motion. Weight bearing is protected for about six weeks, and the brace can usually be discontinued around week seven or eight weeks once you demonstrate adequate quadriceps strength.
Return to sport-specific activities after surgery typically begins around six to seven months, with unrestricted training and full return to high-level sports expected around nine to twelve months. This timeline is longer than ACL recovery because PCL grafts heal more slowly and require careful, progressive loading. In my patients, I emphasize that PCL recovery is a marathon, not a sprint. The good news is that most people achieve stable, functional knees after either conservative or surgical treatment, even though getting back to competitive athletics takes patience. Outcome data shows that patients who follow a disciplined rehabilitation protocol have high satisfaction rates and can return to their desired activities.
PCL Recovery Timeline
Drag the slider to explore each phase of your recovery
Select Your Treatment Path
Tap to switch between timelines — non-operative and surgical recovery have very different timeframes and restrictions.
Injury and Surgery Resources
Discover detailed instructions and protocols to guide patients through Physical Therapy from Dr. Merritt.
Studies Cited
- Shelbourne KD, Muthukaruppan Y. Subjective results of nonoperatively treated, acute, isolated posterior cruciate ligament injuries. Arthroscopy. 2005;21(4):457-461. PubMed
Common PCL Injury Questions
Injury Information
A: With proper rehabilitation, most patients regain functional strength and stability comparable to before the injury. However, the healed ligament may feel slightly different, and athletes sometimes report subtle differences in how their knee responds at the highest performance levels. As I say, “well healed is not the same as never injured.”
A: Conservative treatment uses bracing, ice, and physical therapy to let the ligament heal naturally while strengthening the muscles around your knee to compensate. This works well for partial tears and many Grade II injuries, especially if you’re willing to accept some mild instability. Surgery rebuilds the ligament anatomically, which provides better long-term stability, especially if you want to return to high-level activities or if conservative treatment fails. Surgery is more intensive upfront but often delivers greater stability long-term.
A: Not all PCL injuries require surgery. Isolated Grade I and II tears often heal well with bracing and physical therapy, even in high level athletes. Unlike the ACL, the PCL can actually heal because it sits outside the joint fluid, wrapped in its own synovial lining that protects it from the joint environment. However, I recommend surgery for complete tears with chronic instability, people with multiple ligament injuries, young athletes who fail non-operative treatment, or patients whose knees remain unstable after several months of conservative care. During your consultation, I’ll review your injury grade, your goals, and your activity level to help you make an informed decision.
A: I start with a physical examination, checking how your knee moves and using specific tests like the posterior drawer test to see if your shinbone slides backward. Imaging is important for understanding the full picture. An MRI is the gold standard because it shows the PCL and any other ligaments or cartilage that might be injured, which helps me decide between nonsurgical and surgical treatment. X-rays may also be taken to rule out fractures.
A: The most common early symptoms are pain in the back or inside of the knee, immediate or gradual swelling, and a feeling that your knee is unstable or shifting out of place. Many patients describe a sensation of their knee buckling or feeling looser than normal, especially when going downstairs or changing direction. If you’ve had a direct blow to your knee or a fall and notice these symptoms, you should see a doctor for evaluation.
Surgery Information
A: I commonly use allograft for PCL reconstruction because it eliminates the need to harvest tissue from your own leg, which can cause additional pain and weakness. Allograft tissue is sterilized and tested for safety, and it integrates well with your bone. In some cases, particularly in younger patients with specific goals, I might discuss autograft options such as using your own hamstring or patellar tendon, which we can decide together based on your situation.
A: PCL reconstruction rebuilds the torn ligament by threading a graft through small tunnels drilled in your thighbone and shinbone, positioning it where your original ligament was. I typically use an allograft, which means the graft comes from a tissue bank rather than your own body. This avoids the extra damage that comes with taking tissue from your thigh or hamstring. The surgery takes about an hour and is done arthroscopically, meaning through small incisions with a camera, which minimizes tissue trauma.
Post-Op Recovery
A: Some discomfort is normal, especially in the first few weeks and as you advance your rehabilitation exercises. However, pain should gradually decrease with time and proper treatment. Sharp pain, sudden swelling, or a feeling that your knee is slipping usually means you’ve done too much too soon and you should dial back your activity. If pain worsens or doesn’t improve with ice, elevation, and rest, contact my office so we can evaluate what’s happening.
A: If your job is primarily desk-based, you may be able to return within two to four weeks. If your job involves standing, walking, or manual labor, expect six to twelve weeks off depending on the demands and your healing rate. I’ll give you specific restrictions after surgery and will update them as you progress through physical therapy. Your employer may require a work release from me before you return.
A: Full return to unrestricted sports, including cutting, jumping, and sprinting, is typically nine to twelve months after surgery. Often closer to 12 months or longer. However, you can start sport-specific training drills around six to seven months if you’re progressing well. Some athletes are tempted to return earlier, but returning too soon can re-injure the graft or cause lasting instability. I work with my patients and their trainers to set realistic, injury-preventing timelines.
A: This depends on which knee was operated on and your pain level. For a right knee PCL reconstruction, most people cannot safely operate the gas and brake pedals for at least six weeks while they’re on crutches and in a brace. For a left knee, you might be able to drive sooner if your right leg is fully functional.
A: Physical therapy begins immediately after surgery, even while you’re in the brace. In the first few weeks, we focus on controlling swelling, protecting the graft, and activating your quadriceps through gentle, pain-free exercises. As you progress through the phases over months, we gradually increase strengthening, range of motion, balance work, and sport-specific drills. A structured physical therapy program is critical to your success, and I work closely with your therapist to ensure your rehabilitation stays on track.
A: The first six weeks are focused on protection: you’ll wear a hinged brace, use crutches, and begin gentle quadriceps exercises. Around week six to eight, you can usually discontinue the brace during the day and progress your range of motion. By twelve weeks, most patients have full range of motion and good quadriceps strength. Return to light jogging may begin at five months, but unrestricted sports activities typically aren’t appropriate until nine to twelve months post-op. This is longer than ACL recovery, so patience is essential.
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