Orthopedics

OSPI offers the top orthopedic surgeons in Gilbert AZ and the East Valley. Drs. Mahoney, Macqueen, Stewart and Clouse offer minimally invasive General, Sports and Joint Replacement expertise.

Physical Therapy

Whether you are pre or post-operative, OSPI’s East Valley physical therapy team works with you on both active and passive treatments. Your will be in the best hands with our licensed physical therapists!

Chiropractic

The Gilbert chiropractors at OSPI offer a plethora of nonoperative pain relief options such as manipulations, laser therapy, physiotherapy and electrical stimulation.

Family Practice

OSPI offers comprehensive family practice services including allergy testing, BHRT, medical weight loss, aesthetics and full check ups.

Medical Weight Loss

Patients routinely experience dramatic, healthy weight loss with the customized programs at OSPI. The programs combine nutrition, exercise and prescription weight loss options.

Performance Training

OSPI’s integrated team of healthcare providers work with both amateur and professional athletes to maximize one’s performance with sport specific programs.

Pain Management

OSPI’s Board Certified, Fellowship Trained pain doctor offers both medication management and interventional procedures with exceptional outcomes!

PCL Injury

FAQS on Posterior Cruciate Ligament (PCL) Injury

Posterior cruciate ligament or PCL injury constitutes about a fifth of all knee ligament injuries reported. The ligament is the strongest among all knee ligaments and injuries often remain subtle. This contributes to the relative infrequency of the injury. However, when this primary stabilizer of the knee is injured, the joint becomes instable making other structures within prone to damage.

What is PCL injury?

When the posterior cruciate ligament is sprained or torn, it is known as PCL injury. Dashboard injury is the most common example of PCL injury. When the bent knee hit the car dashboard during an accident, the ligament is injured. This also occurs when on falls on his front knee or excessive force pushing the shin backward.

Grade 1 PCL injury is just a minor sprain damaging a few fibers. However, in Grade 2 injuries, a majority of fibers are damaged causing overall partial tear, pain, swelling, and loss of somewhat knee ability. Grade 3 PCL injury hints at complete posterior cruciate ligament tear with damage to all febers, severe pain, and loss of knee stability.

How does a PCL injury occur?

Posterior cruciate ligament injury is caused by excessive strain on it. Located deep in the knee and connected with the posterior part of the tibia, the ligament is responsible to stabilize femur, tibia, and other structures beneath the articular surface. The ligament does its function by inhibiting “disproportionate twisting, hyperflexion, hyperextension, and backward movement of the tibia on the femur.”

However, if excessive force accompanies these movements, the posterior cruciate ligament is overstretched and its resistance capacity is overwhelmed leading to sprain or tears on it. This causes patient diagnosed with PCL injury.

What are the symptoms of PCL injury? When to see a doctor?

  • Pain with swelling
  • Stiffened knee
  • Difficulty in walking or may walk with a limp
  • Unstable knee
  • Knee giving out feeling
  • Wobbly knee sensation
  • Loss of knee strength and motion

What are causes PCL injury?

  • Powerful direct blow on the front portion of the knee
  • Excessive knee pulling or stretching
  • Fall on a bent knee
  • Knee twisting, hyperflexion, hyperextension,
  • Forceful backward movement of the tibia
  • Misstep while walking or running
  • Hard hit on the shinbone
  • Car accident dashboard injury
  • Collision in contact sports forcing to fall on bent knee
  • Blunt force on the front of the tibia
  • Lateral meniscus tears

How is PCL injury diagnosed?

  • Physical Examination: Symptoms are studied and the knee is examined for motion and swelling. Knowing any medical or injury history linked to the knee also helps identify the exact nature of the posterior cruciate ligament injury.
  • Imaging Tests: Ultrasound or MRI help get a clear picture of exact place of injury and condition of the surrounding muscles and ligaments. On the other hand, x-rays allows to check if any of the bone structure in the knee is injured.

What are the treatment methods available for PCL injury?

  • Self-Care Procedures: Proper rest and care helps healing to PCL injuries. Stop doing any activity that may cause stress or strain on the injured posterior cruciate ligament. Use braces or elastic bandages to support the unstable knee and keep the injured area moderately compressed. Applying ice also helps. Elevation of the injured knee above the heart is also beneficial in reducing swelling.
  • Anti-inflammatory medications and pain relievers help reduce swelling and pain associated with posterior cruciate ligament injury.
  • Physical Therapy: Strengthening exercises are good to restore knee joint mobility and build up muscles around it. But start workouts only after the swelling is stopped and you feel improved knee ability. Strong thigh muscles are found to be beneficial for fast recovery.
  • Joint Aspiration Surgery: When there is significant swelling preventing knee movement, a needle is inserted to take out fluid from the joint. Reduced swelling encourages the healing process.
  • Ligament Reconstruction Surgery: Reattaching the torn ligament parts may not allow the knee to have full pre-injury level ability. Surgical reconstruction of the torn posterior cruciate ligament involves tissue grafting. Tissues from patient’s body or from a cadaver donor are collected and implanted. The procedure requires months of healing and rehabilitation.
  • Prolotherapy (PRP/ Stem Cell Injection): An alternative to the surgical method, the method treats a PCL injury with stem cells or platelet rich plasma taken from the patient’s blood. Mesenchymal cells in the injections produce new cells and tissues replacing the torn and dead ligament tissues. When inserted in large quantities, they bring in overwhelming growth factors and set the repairing process. The procedure is also minimally invasive and performed as outpatient treatment.

References

Schorfhaar AJ, et al. Knee: Lateral and postereolateral injuries of the knee. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 23;sect F.

De Carlo M, Armstrong B. Rehabilitation of the knee following sports injury.Clin Sports Med

Irrgang JJ, Fitzgerald GK. Rehabilitation of the multiple-ligament-injured knee. Clin Sports Med. 2000;19(3):545-571.

Meislin RJ. Managing collateral ligament tears of the knee. Phys Sportsmed. 1996;24(3):67-80.

Mark T. Wheaton & Nicole Jensen. The Ligament Injury-Osteoarthritis Connection: The Role of Prolotherapy in Ligament Repair and the Prevention of Osteoarthritis. Journal of Prolotherapy. 2011;3(4):790-812.

American Academy of Orthopaedic Surgeons (AAOS)

Honkamp NJ, et al. Knee: Posterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds.DeLee and Drez’s Orthopaedic Sports Medicine.

Cosgarea AJ, Jay PR “Posterior Cruciate Ligament Injuries: Evaluation and Management” J Am Acad Orthop Surg, Vol 9, No 5, September/October 2001, 297-307.

Wang CJ. Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee. Chang Gung Med J. May 2002;25(5):288-97.

Margheritini F, Rihn J, Musahl V, Mariani PP, Harner C. Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review. Sports Med. 2002;32(6):393-408.

Pierce CM, et al. Posterior cruciate ligament tears: functional and postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc. Apr 8 2012

Lee BK, Nam SW. Rupture of posterior cruciate ligament: diagnosis and treatment principles. Knee Surg Relat Res. Sep 2011;23(3):135-41

Goudie EB, Will EM, Keating JF. Functional outcome following PCL and complex knee ligament reconstruction. Knee. Sep 29 2009

Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg. Sep-Oct 2001;9(5):297-307.

St Pierre P, Miller MD. Posterior cruciate ligament injuries. Clin Sports Med. Jan 1999;18(1):199-221, vii.

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