Dr Vishal Pai

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Dr Vishal Pai

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PCL Reconstruction

Reviewed by Dr Vishal Pai

Knee surgeonLast reviewed 7 references

A PCL reconstruction, sometimes called a PCL replacement, replaces a torn posterior cruciate ligament with a graft to make the knee more stable. This page covers who it suits, what the operation involves, recovery, results and risks.

At a Glance

  • A PCL reconstruction replaces a torn posterior cruciate ligament with a graft, taken from your own hamstring tendons or from a donor.
  • Most isolated PCL tears are treated without surgery, using a PCL brace and a strengthening program.
  • Surgery is considered when the knee keeps giving way, or when other ligaments are torn as well.
  • You wear a dynamic PCL brace for 12 weeks, and return to sport takes at least 12 months.
  • Surgery usually improves stability and function, but the knee may not feel exactly as it did before the injury.

What is a PCL reconstruction?

The posterior cruciate ligament (PCL) connects the back of the thighbone (femur) to the back of the shin bone (tibia). It stops the tibia from slipping backwards under the femur.

A PCL tear or rupture can lead to symptoms of knee instability. If untreated, these episodes of instability can damage the menisci (the cartilage cushions in the knee) and cause accelerated arthritis in the kneecap.

Side view of the knee showing a ruptured posterior cruciate ligament and the shin bone (tibia) sagging backwards under the femur
A PCL rupture allows the tibia to shift backwards (posterior sag), altering knee mechanics and increasing pressure across the joint.

In some situations, a PCL brace can be used to allow the torn PCL to heal. If there is ongoing instability, a PCL reconstruction is performed. A graft, either your own tendon or donor tissue (an allograft), is used to form the new PCL, which is why the operation is sometimes called a PCL replacement.

Side view of the knee showing a PCL graft with synthetic tape running through tunnels in the femur and tibia, held by buttons
A PCL reconstruction involves using a graft to replace the torn PCL, which aims to restore knee stability. The graft, which lies within bone tunnels, is suspended using metallic buttons.

Who might need a PCL reconstruction?

Most isolated PCL tears are treated without surgery. For a partial tear (grade 1 or 2), you wear a brace that holds the shin bone forward while the ligament heals, and you strengthen your quadriceps (thigh) muscle. Wearing the brace as advised is crucial to healing, and a strong quadriceps can make up for some of the looseness the injury leaves.

Many people do well this way. Over the long term, most people stay active with good strength and movement, although a small number develop arthritis. [1] Most athletes who start treatment within 4 weeks of injury get back to the same or a higher level of sport. [2]

Surgery may be considered if:

  • Your knee keeps giving way despite bracing and rehabilitation
  • The tear is complete (grade 3) and your sport or work is demanding on the knee
  • Other ligaments are torn as well (a multiligament injury), when early stability matters

The decision also depends on your activity level, your expectations and any other injuries. An MRI scan shows the extent of the tear, and Dr Vishal Pai may arrange stress X-rays to measure how far the shin bone moves backwards. Read more about PCL injury.

What is involved in PCL reconstruction surgery?

The steps involved in posterior cruciate ligament reconstruction surgery include:

1. Knee arthroscopy

Keyhole surgery is performed to confirm the PCL tear and identify secondary injury to the cartilage and meniscus. Any secondary injuries are treated during the same procedure.

2. Graft harvest

A graft is harvested, prepared and used to replace the torn PCL. The graft is either your own hamstring tendons (an autograft) or donor tissue (an allograft). The graft choice is discussed between you and Dr Vishal Pai during your consultation and depends on your sporting and work demands. Both types of graft improve symptoms. Results are similar, although knees with a donor graft may be very slightly looser. [3]

3. Tunnel drilling

Bone tunnels are created in the femur and tibia where the PCL normally attaches. The tunnels allow the graft to pass through. An accurate tunnel position matters, because a poorly placed tunnel is a common technical cause of graft failure or looseness.

4. Graft passage and fixation

The graft is passed through the bone tunnels and fixed into place with screws, or over a loop of strong sutures threaded to a button.

How long does it take to recover from a PCL reconstruction?

Recovery after a PCL reconstruction is slow, because the new graft needs protecting while it heals. Your dynamic PCL brace is fitted by an orthotist before surgery, and you wear it for 12 weeks. Physiotherapy starts after your first post-operative visit. Avoid resting with a pillow under your knee, and don’t push your exercises too hard too early, because overly aggressive physiotherapy can stretch the graft. Swelling can last 3 to 6 months. As a rough guide:

  1. Day of surgeryYou will be walking and taking weight on your leg with crutches.
  2. Next dayYou will usually go home the morning after surgery, once a check X-ray has been taken.
  3. 2 weeksYour wound is checked at your first follow-up appointment. People with an office-based job may be able to return to work after at least 2 weeks.
  4. 3 to 4 weeksMost people can stop using crutches.
  5. 6 weeksYou may return to driving and to physically demanding work.
  6. 8 weeksBy this stage, Dr Vishal Pai expects your knee to straighten fully and to bend beyond 90 degrees.
  7. 12 weeksYou can stop wearing your PCL brace.
  8. 4 monthsDr Vishal Pai checks the stability of the graft, and expects your knee to have its full range of movement.
  9. 12 monthsYou are referred for return-to-sport testing. Most people return to sport no earlier than 12 months after surgery.

What results can you expect?

A PCL reconstruction aims to restore the stability of your knee. Most people’s knee function improves after surgery, but the knee often stays a little looser than the uninjured side. [5]

In a review of mostly small studies, knees were less loose after reconstruction than after treatment without surgery, and arthritis was reported about half as often. A similar number of people returned to sport after either treatment. [4] These studies were not randomised, so people who had surgery may have differed from those who did not.

What are the risks and complications?

Every operation carries risks, and Dr Vishal Pai goes through them with you before you decide. The main risks of a PCL reconstruction are:

  • Infection, in fewer than 1 in 400 people, which may need further surgery to wash out the knee and, if it does not settle, removal of the graft
  • Blood clots in the leg, in about 1 in 100 people [7]
  • Stiffness, which occasionally needs a manipulation under anaesthetic if the knee is not bending or straightening by 6 to 8 weeks
  • The graft stretching or tearing again, in about 2 in 100 people, with the risk highest in the first year [6]
  • A numb patch on the inside of the leg after a hamstring graft, which usually improves with time
  • Difficulty kneeling on the operated knee

Rarely, fluid used during the operation leaks into the calf and raises the pressure in the muscles (compartment syndrome), which needs emergency surgery. Injury to the nerve on the outside of the knee (the common peroneal nerve) or to the large artery behind the knee is also rare, but serious. Some people don’t return to their previous level of sport, and the long-term risk of arthritis behind the kneecap is higher than for people who have never injured their knee. You will receive a written information sheet with the full list of risks.

Where does Dr Vishal Pai consult and operate?

Dr Vishal Pai consults at Sandringham Orthopaedic Specialists, Suite 1, 60 Bay Road, Sandringham. He performs PCL reconstructions at Calvary Holmesglen Private Hospital, 490 South Road, Moorabbin, and The Avenue Hospital, 40 The Avenue, Windsor. Patients come from across Bayside, Glen Eira and the Mornington Peninsula, and some travel from regional Victoria.

References

Show all 7 referencesHide references
  1. Shelbourne KD et al. 2013. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. The American Journal of Sports Medicine.
  2. Agolley D et al. 2017. Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up. The Bone & Joint Journal.
  3. Belk JW et al. 2018. Autograft versus allograft for posterior cruciate ligament reconstruction: an updated systematic review and meta-analysis. The American Journal of Sports Medicine.
  4. Schroven W et al. 2021. Operative management of isolated posterior cruciate ligament injuries improves stability and reduces the incidence of secondary osteoarthritis: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy.
  5. Devitt BM et al. 2018. Isolated posterior cruciate reconstruction results in improved functional outcome but low rates of return to preinjury level of sport: a systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine.
  6. Alzobi OZ et al. 2026. Complications related to arthroscopic isolated posterior cruciate ligament reconstruction: a systematic review and meta-analysis of 4162 patients. Orthopaedic Journal of Sports Medicine.
  7. Kammien AJ et al. 2024. Adverse events after isolated posterior cruciate ligament reconstruction: a national database study. Orthopaedic Journal of Sports Medicine.

Frequently asked questions

Is a PCL reconstruction the same as a PCL replacement?

Yes, the two terms describe the same operation. The torn ligament is replaced with a graft made from your own tendon or from donor tissue, so it is often called a PCL replacement. Surgeons usually call it a PCL reconstruction.

PCL tears occur when the knee is placed in a disadvantaged position and cannot withstand the force put through it. They usually happen from a direct blow to the front of the knee when it is bent, such as hitting the dashboard in a car accident or falling onto a bent knee, or from a hyperextension injury. PCL injuries are far less common than ACL injuries.

There is no fixed age limit for a PCL reconstruction. The decision to have surgery depends on your symptoms, how long you have had the PCL tear and whether there is cartilage damage or arthritis in the knee. If you are unsure whether a PCL reconstruction is right for you, Dr Vishal Pai can give you a balanced opinion about the options for your knee.

Yes, there is still a risk of reinjury to your reconstructed PCL. It is important to follow the post-operative instructions from Dr Vishal Pai and your physiotherapist to minimise that risk. A dynamic PCL brace is prescribed for 12 weeks after surgery to protect the reconstruction. The risk is highest in the 12 months after your reconstruction, but is also slightly higher in the 12 to 24 month period.

Before you return to sport, your thigh muscle bulk should match the uninjured side, and you should have good control of your knee, with the ability to perform single-leg squats, hops and other jumping exercises. You will be referred to a physiotherapist for return-to-play testing at a suitable time.

Where the tear can be repaired, preserving the meniscus is preferable to removing it. The meniscus acts like a cushion to support your cartilage. A torn meniscus is a common associated injury when you have a PCL tear, and any meniscal tears are treated at the same time as your PCL reconstruction.

If a meniscal repair is performed, it slows your rehabilitation for the first few weeks, because the repair needs to be protected. You will need two crutches and will put only part or none of your weight on the leg for 6 weeks, and you may need a brace. After that, you resume your PCL rehabilitation as normal. A repair done at the same time as the reconstruction is more likely to heal, because the bleeding into the knee after a PCL reconstruction is rich in growth factors that promote healing. Some repairs still fail, and a tear that cannot be repaired is trimmed (a partial meniscectomy), which may increase the risk of arthritis.

Read more about meniscal repair.

You will be walking and taking weight on your leg with crutches on the day of surgery. Crutches make walking more comfortable, and most people need them for 3 to 4 weeks after surgery. The dynamic PCL brace is worn for 12 weeks.

Contact Dr Vishal Pai’s rooms or your GP, or go to your nearest emergency department, if you notice:

  • Increasing swelling, redness or warmth around the wound
  • A temperature above 38°C for 12 hours or more
  • Drainage from the wound after 72 hours
  • Pain or swelling in your calf
  • Increasing difficulty bending your knee, or a loss of movement after a fall

Call 000 if you have chest pain or shortness of breath.

Next step

Talk through your options

If you are weighing up a PCL reconstruction, Dr Vishal Pai can examine your knee, review your scans and explain all your options, including treatment without surgery.

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PCL Reconstruction

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