PCL Reconstruction Surgery
The posterior cruciate ligament — or PCL — is the strongest ligament in the knee, connecting the femur to the tibia deep within the center of the joint and serving as the primary restraint against the shinbone shifting backward relative to the thighbone. PCL injuries are far less common than ACL tears, but when they do occur — typically from a direct blow to the front of the upper shin (such as a dashboard impact in a car accident or a fall onto a bent knee during sports) — they can produce vague, ill-defined pain behind the knee, moderate swelling, and a subtle instability that many patients initially underestimate. Because PCL injuries often present with less dramatic symptoms than ACL tears, athletes frequently continue playing through the injury, which can lead to progressive cartilage damage, secondary meniscus injury, and the development of early-onset arthritis if the instability is not properly addressed.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with over 30 years of specialized experience in knee ligament surgery — including the complex, technically demanding PCL reconstructions that require a higher level of surgical precision than standard ACL procedures. PCL reconstruction involves navigating critical neurovascular structures at the back of the knee, and the margin for error is significantly smaller than in ACL surgery. With fellowship training at the Southern California Orthopedic Institute/UCLA, membership in the Arthroscopy Association of North America, and more than 15,000 procedures performed, Dr. Glashow has the advanced training and case volume that PCL reconstruction demands. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, he manages PCL injuries in professional athletes where accurate diagnosis and precise reconstruction are essential for career longevity. Named a Castle Connolly Top Doctor every year since 2000, he performs PCL reconstruction at his Upper East Side practice in New York City.
PCL Injury Symptoms and Surgical Treatment
The symptoms following a PCL tear vary from person to person and are often less severe than those of a torn ACL. Patients typically experience vague, ill-defined pain in or behind the knee and only moderate swelling. PCL injuries are most noticeable when walking briskly, running, or walking down stairs — activities that require the knee to decelerate and control backward tibial translation.
Athletes tend to continue playing their sport even with a PCL injury, which can lead to further damage to the cartilage and other structures within the knee. Surgical treatment is recommended when conservative management has not restored adequate stability or when the PCL tear is part of a multi-ligament injury that requires comprehensive reconstruction.
PCL reconstruction is a similar procedure to ACL reconstruction but is somewhat more complex and technically demanding. Dr. Glashow drills narrow tunnels through the tibia and femur, threads a tendon graft — harvested from the patient or from a donor source — through the knee, and secures it to recreate the anatomic path and tension of the original PCL. Over time, blood vessels grow into the graft and seed it with the patient’s own living cells, transforming the graft into a functioning part of the knee’s own stabilizing system.
Post-operative bracing and weight-bearing protocols are determined on a case-by-case basis. In most cases, crutches are used for approximately three weeks, and physical therapy begins within two days of surgery to begin restoring range of motion and preventing stiffness.
If you have sustained a direct blow to the front of your knee, are experiencing pain or instability at the back of the joint, or have been diagnosed with a PCL tear and want to discuss your surgical options, Dr. Glashow provides comprehensive evaluation with same-day imaging at his Upper East Side practice. Whether your PCL injury responds to conservative rehabilitation or requires surgical reconstruction, you will receive the same expert, individualized care that professional athletes trust. Contact our office to schedule your consultation.
Frequently Asked Questions About PCL Reconstruction
What causes a PCL tear?
The most common mechanism is a direct blow to the front of the upper shinbone while the knee is bent — the classic “dashboard injury” in a car accident, where the shin strikes the dashboard and the tibia is driven backward. PCL tears also occur during sports from falling onto a flexed knee, a hyperextension injury, or a combined rotational force. In some cases, the PCL tears as part of a multi-ligament knee injury involving the ACL, MCL, or posterolateral corner — which significantly increases the complexity of treatment.
How is a PCL tear different from an ACL tear?
Both are cruciate ligaments that provide stability within the center of the knee, but they resist movement in opposite directions. The ACL prevents the tibia from sliding forward; the PCL prevents the tibia from sliding backward. ACL tears typically produce a dramatic pop, immediate swelling, and obvious instability. PCL tears tend to present more subtly — with moderate pain, less dramatic swelling, and a vague sense of instability that many patients initially dismiss. Because of this subtler presentation, PCL tears are more frequently missed or underdiagnosed, which is why specialist evaluation with MRI is essential for any significant knee injury.
Do all PCL tears require surgery?
No. Isolated, partial PCL tears — particularly grade 1 and grade 2 injuries where the knee remains functionally stable — can often be managed successfully with bracing and a structured physical therapy program focused on quadriceps strengthening and hamstring control. Surgery is typically recommended for complete (grade 3) PCL tears that produce persistent instability, PCL tears combined with other ligament injuries (multi-ligament knee injuries), and PCL tears in athletes who need to return to high-level competition requiring reliable posterior knee stability. Dr. Glashow evaluates each injury with clinical examination and MRI before recommending a treatment approach.
Why is PCL reconstruction considered more complex than ACL reconstruction?
PCL reconstruction requires the surgeon to work in close proximity to the popliteal artery, popliteal vein, and tibial nerve — the major neurovascular structures that run directly behind the knee. The tibial tunnel must be drilled carefully to avoid these structures, and the graft must be positioned precisely to recreate the PCL’s anatomic attachment without compromising the blood supply or nerve function at the back of the knee. This technical complexity is why PCL reconstruction should be performed by an experienced knee ligament surgeon with specific training in cruciate ligament surgery.
What does recovery look like after PCL reconstruction?
Recovery follows a structured rehabilitation protocol that is generally slower and more conservative than ACL reconstruction, because the graft at the back of the knee is under constant gravitational stress when the knee is bent. Patients typically use crutches for three to four weeks and wear a brace that limits flexion to protect the graft in the early healing phase. Physical therapy begins within the first few days and progresses through range-of-motion recovery, quadriceps strengthening, and gradual return to functional activities over several months. Most patients return to daily activities within two to three months and to full sports between nine and twelve months after surgery. Dr. Glashow coordinates rehabilitation closely with physical therapists to ensure the graft heals under optimal conditions.
Can a PCL tear lead to arthritis if left untreated?
Yes. An untreated complete PCL tear allows the tibia to shift backward during weight-bearing activities, which alters the contact mechanics within the knee and places abnormal stress on the cartilage — particularly in the medial compartment and the patellofemoral joint. Over time, this abnormal loading pattern accelerates cartilage wear and can lead to early-onset osteoarthritis. This is one of the primary reasons Dr. Glashow recommends careful evaluation and treatment planning for all PCL injuries, even those that seem mild at first — because the long-term consequences of chronic posterior instability can be significant.
