KNEE

Physiotherapist Department
2019

KNEE
General Anatomy
PCL Injury
 Anatomy

1. Origin and Insertion 

From the anterolateral aspect of the medial femoral condyle within the notch, the PCL
inserts along the posterior aspect of the tibial plateau, approximately 1 cm distal to the joint
line

2. Function 
o Prevent excessive posterior translation of the tibia compare to the femur.
o Prevent hyper extension and limit internal rotation valgus and varus of
the knee joint.

3. Mechanism of Injury
o Hyperextension (example: shooting in the air)
o Falling on a bent knee (a fall onto the knee with the foot in a plantar
flexed position)
o Excessive external rotation of the tibia in Varus Stress with a bent knee
and a plantar-flexed foot (example: being tackled when your knee is bent)

4. Diagnosis :
Context :
- Emergency : go directly to the hospital
o X-ray
o MRI
o Ultra sound
- Non – emergency
o Mechanism of injury
o Contact or Non contact
o First injury or re – injury
o Name, age, …
o Test (Use Ice and cool the player down before Clinical test)
 5. Clinical Test :

.Posterior Drawer Test

Patient: on the back, the hip at 45° of flexion and the knee at 90° of flexion
Practitioner: at the knee side you want to test, sit on the patient’s toes to help stabilize
Action: Grasp the proximal lower leg, approximately at the tibia plateau, and attempt to
translate the lower leg posteriorly
Conclusion:
 Negative: noticeable end-feel and minimal movement
 Positive: absence of an end-feel and the proximal tibia falls back (excessive
translation).  The amount of posterior movement determines the grade of PCL
tear.
o Grade 1 = 0 - 5 mm
o Grade 2 = 6 - 10 mm
o Grade 3 = 11+ mm

.Lachman’s test
Patient: on the back, the knee at 20 - 30° of flexion, the leg should also be slightly externally
rotated
Practitioner: at the knee side you want to test, hold the femur firmly with one hand to
prevent motion of the upper leg and relax the hamstrings, Place the thumb of the other
hand on the anterior side of the tibia and grasp the posterior side of the tibia near the joint
line with the fingers
Action: apply a brisk posterior-to-anteriorly force through the tibia (tug forward)
Conclusion:
 Negative: noticeable end-feel and minimal movement
 Positive: tibia will rest further posterior than usual

.Posterior sag sign

Patient: on the back, the patient’s leg should be relaxed
Practitioner: at the knee side you want to test, Observe the position of the tibia in
comparison to the femur on both side
Action: raise the leg until the hip and knee are at 90° of flexion, support the leg under the
lower calf or heel in the air
Conclusion: In the absence of a PCL, the tibia appears to "sag."

 Publication / Reference :
Posterior Drawer Test
https://www.physio-pedia.com
https://www.ebmconsult.com/
https://youtu.be/HTti7-c1MFk
Lachman’s test
https://youtu.be/bHytLhg-1vM
Posterior sag sign
https://youtu.be/zRWDQDIxtps
https://www.ebmconsult.com/
https://www.thestudentphysicaltherapist.com/posterior-sag-sign.html
 6. Type of treatment :
Depend on the context
- Non surgery : the most common treatment
- Surgery : in case lack of stability

7. Rehabilitation :
Non-sugery :
Phase Time Objective Rehabilitation
1 0 – 4 weeks Walking normally The Police Principle
Physio :
 ↓ Swelling and Pain :
Game Ready, Mobilization
 Maintain Strength and
Endurance : Core, Glutes,
Hamstring, Quadriceps,
Calf muscles.
 Balance.
 Increase Weight Bearing
from 50% to 100% without
pain
 Move With Support
(braces, crutches).
 Pool

Able to walk normally without pain

and supports (Crutches, Cast) AT THE
END OF THE PHASE.

2 5 – 8 weeks Walking normally Continue to decrease swelling if

with more needed
confidence and Exercises :
stability of the  Upper leg and Lower leg :
knee Quads, Hamstrings, Glute,
Calf muscles, Adductors,
Pelvis muscles etc.. (no
weight)
 Core Stability
 Balance on 2 legs
 Increase knee stability
Maintain Aerobic Capacity :
Stationary Bike, Pool etc..

3 9 – 12 weeks Improve Unilateral Exercise :

Strength - Prepare  Lower limbs : Quads,
to run Hamstrings, Glute, Calf,
Adductors, Pelvis muscles
 etc..
 Core Stability.
 Balance on 1 leg.

Aerobic Capacity : restore fitness

level
 Bike.
 High Intensity Training.
 Pool.

Should be pain-free at the end of this

phase to move next phase
4 13 – 16 Running and RTT Re-learn to run (pliometric exercises)
weeks  Run : on treadmills (speed
changing), on ground
(speed, change of direction
…)
 Aerobic capacity : bike,
treadmills, pool …
 Exercise with ball
 Pliometric : low / mid /
high intensity, 1 leg or 2
legs, endurance, stability

Test :
 Biodex
 Jump Test
 Fitness Test

Exercises :
 Strength (whole leg)
 Aerobic Work : with ball or
not
 Change Of
Direction/Cutting/ Pivot
Training (Progressive)
 Pitch Session (include all
exercises)

Contact training needed at the end of

the phase

For the Surgery Situation : we use the same protocol for ACL Reconstruction Rehab Plan