From the Guidelines
For a PCL injury, I recommend using a functional knee brace that provides support for mild to moderate PCL instability, as it offers some control of external knee rotation and anteroposterior joint translation 1. When selecting a functional knee brace for a PCL injury, consider the following key features:
- A posterior force application system to prevent the tibia from moving backward relative to the femur
- A design that provides augmented knee proprioception
- A brace that can be worn during all physical activities for at least 6-12 weeks following injury, depending on severity and your doctor's recommendation It is essential to note that functional knee braces are not a replacement for appropriate rest, rehabilitation, and possibly surgical intervention for severe tears. The brace should be used in conjunction with prescribed physical therapy exercises to strengthen surrounding muscles, as lower extremity muscle strengthening, flexibility improvements, and technique refinement are more important than functional bracing in treating ligamentous knee injuries 1. Additionally, the correct application of the functional knee brace depends on appropriate rehabilitation and activity modification, and it is crucial to ensure that the brace is positioned correctly, with the hinges aligned with the knee joint and the posterior support pad properly placed behind the calf. While functional knee braces have not been shown to be harmful, their objective effects appear to diminish at physiologic stress levels, and brace wearers consistently report subjectively improved knee stability and function 1.
From the Research
Treatment for Posterior Cruciate Ligament (PCL) Injury
- The treatment for PCL injury can be conservative or surgical, depending on the severity of the injury and the presence of other knee injuries 2, 3.
- Conservative treatment for isolated PCL tears typically involves intensive quadriceps exercises, a short period of immobilization (less than 2 weeks), and early controlled activities and weightbearing 2.
- The use of a knee brace may be recommended as part of the conservative treatment to provide support and stability to the knee 4.
- Surgical treatment is usually recommended for PCL avulsion fragments that have been dislocated, or for combined PCL injuries with other knee injuries 2, 5.
- The goal of treatment is to restore native knee kinematics and prevent residual posterior and combined rotatory knee laxity through an individualized approach 5.
Knee Brace in PCL Injury Treatment
- A knee brace can be used to provide mechanical support for the collateral ligaments during valgus or varus stress of the knee 2.
- The knee brace can help to reduce posterior laxity and provide stability to the knee, allowing for early controlled activities and weightbearing 4.
- However, the effectiveness of knee braces in treating PCL injuries has not been extensively studied, and more research is needed to determine their role in treatment 3, 6.
Considerations for Treatment
- The treatment approach should be individualized based on the severity of the injury, the presence of other knee injuries, and the patient's overall health and activity level 5, 6.
- The goal of treatment is to minimize residual instability, osteoarthritic progression, and failure of additional concomitant ligament graft reconstructions or meniscal repairs after treatment 6.
- Further research is needed to determine the most effective treatment approaches for PCL injuries, including the use of knee braces, and to establish evidence-based guidelines for treatment 3, 6.