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Posterior cruciate ligament (PCL) injuries are difficult to detect because patients rarely present with findings that suggest a severe ligament injury. The keys to diagnosis include learning the mechanism of injury and performing a posterior drawer test. A complete knee exam rules out associated injuries. Nonoperative treatment is indicated for low-grade, isolated PCL injuries, but patients should be monitored for any degenerative changes. Combined injuries, high-grade injuries, and avulsion fractures require surgery. Rehabilitation goals for all PCL injuries include regaining full range of motion and quadriceps strength.

In brief Posterior cruciate ligament (PCL) injuries typically occur during hyperflexion or with a blow to the knee during hyperextension. Physical findings such as a positive posterior drawer test or a posterior sag and standard x-rays are keys to expedient diagnosis. Acute isolated PCL injuries often are treated conservatively with strengthening and proprioceptive exercises. Chronic isolated PCL injuries and combined ligament injuries usually require surgical reconstruction.