ACL and PCL Reconstruction

Medically reviewed by Dr. K. G. Gopalakrishna, Consultant Orthopaedic Surgeon · Last reviewed: August 2026

Keyhole surgery for ACL and PCL ligament injuries of the knee.

The ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) are the two central ligaments that keep the knee stable during movement, each controlling a different direction of motion. Both can tear from injury, and while ACL tears are far more common, PCL injuries carry their own distinct causes and treatment considerations. When surgery is needed, both are reconstructed using keyhole (arthroscopic) technique rather than open surgery, allowing a graft to be placed with minimal disruption to the surrounding joint.

Types

Common Causes

ACL and PCL tears usually happen through different mechanisms, which is one reason they are considered separately even though both are treated with similar reconstruction techniques.

• ACL - sudden pivoting or direction change, common in football, basketball, and similar sports.
• ACL - awkward landing from a jump, placing excessive twisting force on the knee.
• ACL - direct impact to the knee during a collision or tackle.
• ACL - sudden deceleration while running at speed.
• PCL - a direct blow to the front of the shin, classically a dashboard injury during a road traffic accident.
• PCL - falling heavily onto a bent knee with the foot pointed downward.
• PCL - hyperextension of the knee, forcing the joint to bend backward beyond its normal range.
• PCL - a forceful blow to the front of the knee during contact sports such as football or rugby.
• PCL - road traffic accidents involving high-speed impact, one of the most common causes of significant PCL injury.
• Combined injuries - typically from higher-energy trauma involving significant force to the knee.
• Pre-existing knee looseness increasing susceptibility to ligament injury of either type.

Signs and Symptoms

• A popping sensation at the moment of injury
• Rapid swelling within hours, especially with ACL tears
• A feeling of the knee being unstable or giving way, particularly with ACL injuries
• Vague, sometimes milder knee discomfort with PCL injuries, occasionally making them easier to overlook initially
• Difficulty continuing activity immediately after the injury
• Pain at the back of the knee, more typical of PCL injury

Diagnosis

Diagnosis is based on a clinical examination testing knee stability in different directions, since ACL and PCL injuries are identified using different specific stability tests. An MRI confirms the diagnosis and identifies which ligament, or ligaments, are affected, along with any associated meniscus or cartilage damage.

Treatment Approach

Treatment depends on which ligament is involved, the severity of the tear, and the patient's activity goals. ACL tears in patients wishing to return to pivoting sports generally need surgical reconstruction, while some PCL tears - particularly partial ones - can be managed without surgery if the knee remains reasonably stable. When reconstruction is needed, it is performed arthroscopically using a tissue graft, followed by a structured rehabilitation programme. Dr. K. G. Gopalakrishna assesses which ligament is affected and discusses surgical and non-surgical pathways individually based on the specific injury and the patient's activity demands.

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Last reviewed: August 2026