POSTERIOR CRUCIATE LIGAMENT

The posterior cruciate ligament (PCL) is the strongest ligament in the knee joint. Its function is to prevent the lower leg from slipping backwards in relation to the thigh. An injury to the posterior cruciate ligament occurs when high forces are applied, e.g. in bicycle and motorcycle falls on the bent knee or other high-speed injuries.

In comparison to the anterior cruciate ligament, injuries of the posterior cruciate ligament are rarer, but they are also the most frequently overlooked injury in the knee joint, which often results in inadequate, no or even incorrect treatment. Therefore, the detailed history and diagnosis is particularly important.

Since Prof. Schoettle also dedicated parts of his PhD thesis to the research and treatment of the PCL and treated this injury almost daily at the trauma department of the Charité in Berlin, his experience in this field is above average.

NON-OPERATIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT RUPTURE

The acute, isolated injury of the posterior cruciate ligament basically has a good self-healing potential, since the posterior cruciate ligament has its own blood supply. In the first 6 weeks, the M4 PCL dynamic splint designed by Prof. Dr. med. Schöttle and now used internationally by top US athletes in particular will be adapted for this purpose. If there are no accompanying injuries, crutches must only be used in cases of pain. In contrast to all other splints for the treatment of the posterior cruciate ligament rupture, this unique splint makes it possible to push the lower leg forward with free mobility and thus relieve the load on the posterior cruciate ligament. This allows the posterior cruciate ligament to activate its self-healing function and stabilize in its anatomical position. Since the knee can be moved, muscle exercises can be started in parallel. At the same time, a purely conservative therapy of the injury of the posterior cruciate ligament should also include cell therapy – either in the form of blood plasma/growth factors (ACP, PRP) or the significantly higher anti-inflammatory and regenerative effect of a much more effective stem cell therapy to maximize the chances of self-healing.

It is known that an injury to the posterior cruciate ligament that is detected early on can be treated conservatively – i.e. without surgery – without accompanying injuries. However, this treatment consisted of a complete immobilization in stretching, so that the patients developed a muscle deficit that they had to catch up. Also, the splint was often not worn consistently and movement deficits were the result.

In order to avoid these problems and consequences, Prof. Dr. med. Philip Schöttle and orthopedic technicians developed a splint that pushes the shinbone forward with a controlled force. This relieves the load on the posterior cruciate ligament and allows movement at the same time. This increases the patient’s wearing comfort and willingness to wear a splint and minimizes the muscle deficit. The first renowned patient was Patrick Herrmann, player of the first Bundesliga soccer team Borussia Mönchengladbach, who was able to return to the pitch without surgery after a few weeks.

This new development enables conservative and postoperative early, dynamic and functional treatment of (partial) ruptures of the posterior cruciate ligament. The support pad of the M.4s PCL dynamic orthosis holds the tibia in the desired position. The mechanism is precisely adjusted with the integrated rotary knob to relieve and protect the posterior cruciate ligament. The aim is to quickly mobilize patients again. Early and targeted movement has a positive effect on functionality and musculature.

Advantages of the dynamic HKB rail:

- The innovative support pad acts actively on the tibia and holds it securely in the desired position.
- Due to its shell shape, the pad adapts ideally to the calf.
- The integrated rotary wheel allows an exact and individual adjustment of the support pad.
- The lateral number scale facilitates the (re-)adjustment of the support pad.
- The patented physio glide joint optimally imitates the roll-slide movement at the knee. This ensures that the orthosis sits securely on the leg.
- The slender joint construction makes it possible to wear under clothing.
- The wing shape of the tibia pad optimally adapts to the anatomical shape of the tibia.
- The pressure is distributed effectively and pleasantly.

PCL SURGERY

Surgical therapy is only necessary if, in addition to the PCL, other structures are also injured or if there is chronic instability, as the injury has primarily been overlooked or has not been adequately treated. Like the ACL reconstruction, this procedure is carried out in a gentle arthroscopic procedure, whereby as many parts of the posterior cruciate ligament as possible are preserved.

In order to enable a quick exercise under completely pain-free conditions, Prof. Schoettle performs this procedure with an inpatient stay of 2 nights. Already the day after the operation, you will be mobilized with the help of his sports therapy team and will learn to activate your muscles yourself.

POST OP

In comparison to the anterior cruciate ligament, the post op treatment is somewhat longer since the PCL graft must be protected against the backward force of the lower leg during the first weeks of healing. While crutches only have to be used for simultaneous meniscus injuries or pain, it is highly recommended to wear the special PCL splint during the first 6 weeks not only during the day but also at night. In the following 6 weeks, the dynamic splint must only be worn during the day.

While you can start your upper body and above all your core muscles (deep back and abdominal muscles) directly after the operation, you can start light sports activities with the operated knee under guidance already 6 weeks after surgery.

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