PCL Reconstruction

Overview

The posterior cruciate ligament (PCL) is one of the key stabilising ligaments of the knee. In cases where a PCL tear results in significant joint laxity or occurs as part of a multi-ligament knee injury, surgical reconstruction may be required to restore knee stability and function. See PCL Tears under Knee Conditions for further information.

PCL reconstruction involves replacing the torn ligament with a tendon graft. The graft is most commonly taken from the patient’s own tissue (autograft), such as the hamstring, quadriceps, or patella tendon. In some cases, allograft donor tissue is used. Dr Free will discuss graft options with you prior to surgery. The procedure is performed using minimally invasive arthroscopic techniques to promote faster recovery and minimise tissue trauma.

What does PCL reconstruction involve?

The steps involved in PCL reconstruction are as follows:

Knee arthroscopy - The procedure begins with an arthroscopic examination of the knee to identify and address any associated injuries, such as meniscus tears or cartilage damage. Any additional injuries will be treated at the same time.
Graft harvesting - If an autograft is used, the chosen tendon (hamstring, quadriceps, or patella tendon) is carefully harvested.
Tunnel creation - Precise tunnels or sockets are drilled into the femur and tibia at the anatomic PCL attachment sites. Because the PCL is larger than the ACL, a thicker graft is used to replicate its natural structure and biomechanics.
Graft fixation – The graft is positioned and secured with strong, biocompatible screws or buttons to restore stability.

Advanced surgical planning and arthroscopic visualisation ensure optimal graft placement, tension, and alignment for long-term knee function.

Procedure preparation

Please refer to the Pre-operative information page for guidance on preparing for your procedure.

PCL reconstruction recovery

Inpatient stay

Most patients stay in hospital overnight following surgery.

First 2 weeks

Dressings - Keep dressings in place until your first post-operative review (2 weeks). If a dressing becomes wet or soaked with blood, it may be replaced, but do not clean the incision or apply creams.
Compression - Wear the Tubigrip compression sleeve at all times except for icing or showering.
Swelling - Ice your knee for 20 minutes several times a day, use compression, and elevate your leg regularly.
Weight-bearing - You can place full weight on the leg, but must use crutches until normal walking and full range of motion are restored (usually ~6 weeks).
Brace - A PCL brace must be worn at all times for at least 6 weeks, except when showering.
Range of motion - You will be able to work on your range of motion immediately after surgery. You should do exercises every day working on getting your knee straight (flat to the bed), as well as working on knee flexion (bend).

Weeks 2-12

The focus during this phase is on restoring normal knee function:

Continue using crutches until walking without a limp
Maintain daily range of motion exercises
Re-establish normal walking patters
Introduce gentle, controlled resistance exercises
You should regain full range of motion and normal walking patterns during this stage

3 months+

Rehabilitation now focuses on:

Timeframes to return to high-demand sports vary depending on your recovery progress, strength, and functional testing outcomes. Most patients can expect to return to sport no earlier than 9-12 months post-surgery.

Dr Free is highly experienced in diagnosing and treating complex ligament injuries of the knee, including PCL tears. He uses the latest surgical techniques and evidence-based rehabilitation protocols to help patients return to sport, work, and daily life with confidence. Whether your injury is fresh or long-standing, Dr Free can provide a clear diagnosis, explain all treatment options, and develop a personalised plan to achieve the best possible outcome and optimise long-term knee health.