PCL Injury (Posterior Cruciate Ligament Tear) and Specialist Bracing in Bath & Bristol

A PCL injury is damage to the posterior cruciate ligament, a major stabilising ligament in the centre of the knee. The PCL helps prevent the shin bone (tibia) moving too far backwards under the thigh bone (femur) and contributes to rotational stability–especially when the knee is bent. PCL injuries range from mild sprains to complete tears and can occur alone or as part of a multiligament knee injury.

Mr Simon Abram, Consultant Specialist Knee Surgeon, provides specialist assessment and treatment for PCL injuries in Bath and Bristol.

What does the PCL do?

The PCL sits behind the ACL in the centre of the knee. It helps:

Prevent the tibia moving backwards (posterior translation)
Stabilise the knee in deeper bend (stairs, slopes, squats)
Work with the posterolateral corner (PLC) and other structures to control rotation

When the PCL is deficient, the tibia can sit slightly “sagged” backwards, which can change knee mechanics and lead to symptoms during downhill walking, stairs, and sport-specific deceleration.

How PCL injuries happen

PCL tears are often caused by a force that drives the shin backwards, for example:

Dashboard injury (knee hits the dashboard in a road traffic collision)
Fall onto a bent knee (impact to the front of the shin)
Sporting collision (contact to the front of the tibia)
Knee dislocation / high-energy trauma (often with other ligament injuries)

PCL injuries are sometimes combined with injuries to the PLC, MCL, or ACL. Identifying these combinations is essential because they change management.

Symptoms of a PCL injury

Pain and swelling after injury (sometimes less dramatic than an ACL tear)
Difficulty trusting the knee, particularly on slopes or stairs
A sense of “heaviness” or instability during deceleration
Giving way in deeper flexion or when changing direction
Reduced performance in sport or difficulty returning safely to high-demand activity

Red flags

Seek urgent assessment if you have suspected knee dislocation, numbness/weakness in the foot, a cold/pale foot, severe swelling, or inability to weight-bear.

Grading: how severe is the tear?

PCL injuries are commonly described as:

Grade 1: mild sprain, minimal looseness
Grade 2: partial tear with increased looseness
Grade 3: complete tear with significant posterior instability

Grade matters, but the treatment plan is based on your symptoms and function, not the scan alone.

Assessment and diagnosis (Bath & Bristol)

Accurate diagnosis matters because PCL injuries can be missed early and because the best management depends on whether the injury is isolated or combined. Mr Simon Abram offers specialist PCL assessment in Bristol and Bath.

Assessment usually includes:

History: mechanism of injury, swelling timing, instability symptoms, sport/work demands
Examination: posterior laxity testing and full ligament assessment (ACL/MCL/LCL/PLC)
X-rays: to assess fractures and avulsion patterns (where the ligament pulls off a bone fragment)
MRI scan: to confirm the tear and identify meniscus, cartilage, and other ligament injuries

Specialist PCL bracing: why it’s different (and why it matters)

Modern non-operative PCL care often includes a specialist PCL brace that is designed to reduce the backward “sag” of the tibia while the ligament heals. This is different from a standard hinged knee brace.

How a specialist PCL brace works

It applies an anteriorly directed force to the upper shin, helping hold the tibia in a better position.
Many specialist designs are dynamic, meaning the supportive force increases as the knee bends–when the PCL is under greater strain.
The goal is to support a more favourable healing position and reduce stretching during recovery.

Common brace terms you may hear

Dynamic PCL brace
Anterior drawer brace
PCL “jack” brace (a style designed to hold the tibia forward)

How long is bracing used?

Protocols vary depending on tear severity and your knee’s stability, but specialist bracing is usually needed for several months in higher-grade isolated PCL injuries. Your plan is tailored to your examination findings, imaging, symptoms and goals, with guidance from your surgeon and physiotherapy team.

Important: the brace is an aid, not a substitute for rehabilitation. Best outcomes come from specialist bracing combined with structured physiotherapy and appropriate progression back to sport.

Non-surgical treatment (common for isolated PCL injuries)

Many isolated PCL injuries can be managed without surgery, especially if the knee feels stable in daily life and you are not experiencing significant functional giving way.

Non-operative treatment typically includes:

Specialist PCL bracing (particularly for higher-grade tears or symptomatic posterior sag)
Physiotherapy to restore movement and rebuild strength and control
Quadriceps strengthening (key for controlling posterior tibial position)
Activity modification during healing and early rehabilitation
Criteria-based return to running and sport (based on function, strength and confidence)

When surgery is considered

Surgery is considered when symptoms persist, instability is significant, or the injury pattern is complex.

PCL surgery may be recommended when:

There is persistent functional instability despite high-quality rehabilitation and bracing
The injury is high-grade and the knee remains clearly unstable
You have a high-demand goal and the knee cannot cope safely
There is a combined ligament injury (especially PCL + PLC), where reconstruction is often required for durable stability
There is a PCL avulsion injury that is suitable for fixation (selected acute cases)

PCL fixation and PCL reconstruction options

PCL avulsion fixation (selected acute cases)

Sometimes the PCL pulls off a fragment of bone (an avulsion). If the fragment is displaced and the pattern is suitable, surgery may involve reattaching the fragment to restore ligament function.

PCL reconstruction

PCL reconstruction rebuilds the ligament using graft tissue. It is most commonly performed for chronic or high-grade instability, or as part of multiligament reconstruction. Surgery is planned to:

Restore posterior stability and reduce symptomatic “sag”
Address associated injuries at the same time (meniscus, cartilage, ACL, PLC)
Optimise stability through the full range of knee movement

Bracing after PCL surgery

Specialist bracing is also commonly used after PCL fixation or reconstruction. The goal is to protect the reconstruction while healing occurs, particularly in knee flexion where posterior forces are higher. Brace settings and duration are individualised and may be adjusted if other procedures (such as PLC reconstruction or meniscal repair) are performed at the same time.

Combined injuries: why PLC and alignment matter

PCL injuries commonly occur with posterolateral corner (PLC) injuries in more severe trauma. This combination is important because the PLC contributes to rotational stability and helps protect a PCL graft. If PLC laxity is not recognised and treated, outcomes can be compromised.

In chronic cases, limb alignment may also influence stability and long-term success, and can be considered in treatment planning.

Recovery and rehabilitation

Rehabilitation is essential whether treated non-surgically or surgically.

Non-surgical recovery

Swelling control and restoring full extension
Progressive quadriceps-led strengthening and movement control
Specialist bracing as advised to support tibial position during healing
Return to sport based on milestones and objective testing when appropriate

After surgery

Bracing is typically used early to protect healing tissues
Weight-bearing and range of motion progression are guided by your procedure and any additional repairs
Strengthening progresses in stages, with careful management of posterior shear forces early on

Risks and considerations

All surgery carries risks. PCL injury management considerations may include:

Infection, blood clots, stiffness, prolonged swelling
Persistent laxity or ongoing instability symptoms
Graft failure or need for further surgery (if reconstruction is performed)
Ongoing pain or difficulty returning to high-demand sport
Post-traumatic osteoarthritis risk after significant ligament injury

Frequently asked questions

Can a PCL tear heal without surgery?

Many isolated PCL tears can be managed successfully without surgery. Physiotherapy is important, and specialist PCL bracing is often used to help reduce posterior tibial sag during healing. Surgery is considered if functional instability persists or if there is a combined ligament injury.

Do I need a specialist PCL brace?

Not everyone does. A specialist brace is more likely to be recommended for higher-grade tears, symptomatic posterior sag, or when your goals require reliable stability. The decision is based on your examination, imaging, symptoms and activity requirements.

How is a PCL injury different from an ACL injury?

The ACL primarily controls forward movement and rotation, while the PCL primarily controls backward movement of the tibia and stability in deeper knee bend. PCL injuries are often caused by a direct blow to the shin when the knee is bent.

When would PCL reconstruction be recommended?

PCL reconstruction is considered when there is persistent functional instability despite rehabilitation (often including specialist bracing), when the tear is high-grade and symptomatic, or when the PCL injury is part of a multiligament injury pattern (especially PCL + PLC).

Can I be assessed for a PCL injury in Bristol or Bath?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for PCL injuries in Bath and Bristol, including non-surgical pathways with specialist bracing and physiotherapy, avulsion fixation when appropriate, and reconstruction strategies for complex or persistent instability.