The posterior cruciate ligament (PCL) is the strongest ligament in the knee — and injuries to it are far less common than ACL tears, which is exactly why they are also more often missed on a first evaluation. Dr. Ankit Chaudhari at Ashirwad Hospital brings the specific clinical attention a PCL injury needs: its symptoms are subtler than other knee ligament injuries, and an inexperienced evaluation can easily overlook or underestimate it.
The posterior cruciate ligament is one of the four major ligaments of the knee, running through the back of the joint and connecting the thigh bone (femur) to the shin bone (tibia). Its primary role is to prevent the shin bone from sliding too far backward relative to the thigh bone, providing stability during activities involving rapid acceleration and deceleration.
Unlike ACL tears, PCL injuries do not always announce themselves with a dramatic pop or immediate severe instability. Many patients with a significant PCL tear continue playing or walking after the injury, attributing the discomfort to a general knee sprain — which is one of the main reasons PCL injuries are underdiagnosed. This makes a thorough, experienced evaluation essential to avoid missing the injury or underestimating its severity. At Ashirwad Hospital, diagnostic imaging alongside specific clinical tests provides the accurate grading that determines the correct treatment path.
PCL injuries are also specifically associated with road accidents where the knee strikes the dashboard on a bent leg — a very common injury mechanism in Surat given the high incidence of road traffic accidents across the city.
A direct blow to the front of the shin below a bent knee — most classically in road accidents where the knee strikes the dashboard. A hard fall directly onto a bent knee. Sports injuries involving a direct impact to the knee in contact sports such as kabaddi, wrestling, or football. Hyperextension injuries of the knee during sports or accidents.
PCL injuries present with subtler symptoms than ACL tears — the instability is posterior (backward) rather than the more dramatically felt rotational instability of ACL injury. The posterior drawer test and posterior sag sign are the specific clinical tests that identify a PCL injury and are only reliably performed by a clinician experienced with this ligament.
Pain at the back of the knee. Swelling that may be less dramatic than ACL swelling. A vague sense of instability, particularly with stairs and inclines. Difficulty with deceleration and sudden direction changes. Posterior knee pain that worsens with kneeling or flexion under load.
PCL injuries frequently occur alongside other knee ligament injuries — particularly the posterolateral corner (PLC), the ACL in high-energy injuries, and the medial and lateral collateral ligaments. Missing an associated posterolateral corner injury is one of the most significant errors in knee ligament surgery, and full MRI evaluation is essential at Ashirwad Hospital before any treatment decision is made.
PCL injuries are classified by severity, and the grade significantly influences the treatment approach. Accurate grading — using clinical examination together with MRI from the diagnostics and imaging centre at Ashirwad Hospital — is essential, since PCL injuries are known to be subtler and more easily underestimated than ACL tears on a routine examination.
The ligament is stretched but largely intact, with mild laxity on clinical testing (<5 mm posterior tibial displacement). Often heals well with a structured rehabilitation programme alone. Surgery is not typically required. Most patients return to full function with appropriate physiotherapy and activity modification through the non-surgical treatments pathway.
A more significant partial tear with moderate laxity (5–10 mm posterior displacement). Knee instability may become a functional problem depending on the patient’s activity level. Many grade 2 injuries are managed non-surgically in lower-demand patients, but athletes and physically active individuals may benefit from surgical intervention — particularly if there is associated ligament involvement.
The ligament is no longer functional, with significant posterior laxity (>10 mm displacement). Surgery is generally required, especially if other knee ligaments are also injured. Grade 3 isolated PCL injuries may occasionally be managed non-surgically in low-demand patients, but multi-ligament injuries involving the PCL almost universally require surgical reconstruction.
Patients often assume any ligament surgery is the same, but PCL treatment involves two distinct surgical approaches chosen based on the specific injury, its timing, and the quality of the remaining tissue. This distinction is why early, accurate diagnosis matters specifically for PCL injuries — repair is only possible within a certain window after the injury.
Not every PCL injury requires surgery — and at Ashirwad Hospital, the treatment recommendation is always based on the specific grade, the patient’s activity demands, and whether associated injuries are present. Many grade 1 and some grade 2 injuries are managed successfully through a structured non-surgical rehabilitation programme.
The tear is a complete grade 3 injury. Significant, functionally limiting instability is present. Other knee ligaments or structures are also injured — particularly the posterolateral corner. Non-surgical management has not resolved instability affecting daily activity or sport over a period of structured rehabilitation.
The tear is grade 1 with minimal laxity and no associated ligament injury. The patient has low activity demands and can manage with activity modification. Grade 2 tears in older or lower-demand patients who are willing to avoid high-loading activities. Non-surgical management includes structured physiotherapy through the non-surgical treatments pathway at Ashirwad Hospital.
A structured physiotherapy programme focussing specifically on quadriceps strengthening — since the quadriceps provide a dynamic substitute for the PCL’s static stabilising role. Hamstring strengthening is introduced carefully to avoid posterior tibial loading. Proprioceptive retraining. Activity modification to avoid high-risk loading patterns. Regular clinical review to assess whether instability is developing.
PCL surgery is generally performed using arthroscopic, minimally invasive techniques — consistent with the approach used across the minimally invasive HD arthroscopy service and the arthroscopy and sports injury department at Ashirwad Hospital. The procedure is planned individually for each patient based on the grade of injury, the repair versus reconstruction decision, and any associated ligament or meniscus involvement.
MRI review to confirm the grade of PCL injury and identify any associated ligament injuries — particularly the posterolateral corner, ACL, and collateral ligaments. General fitness and anaesthesia assessment. Decision on repair versus reconstruction discussed with the patient, including the reasoning specific to their injury pattern and timing of presentation.
PCL surgery at Ashirwad Hospital is typically performed under spinal or general anaesthesia. Careful patient positioning is essential for PCL surgery since the posterior knee structures need to be accessible, which requires specific positioning techniques differing from standard ACL reconstruction positioning.
The arthroscope is introduced to systematically assess the knee joint — the PCL, ACL, menisci, cartilage surfaces, and posterolateral corner are all evaluated under direct vision and by probing. Any associated meniscus tear is assessed and either repaired or partially resected at this stage.
For repair: the torn PCL is identified and sutures are placed through the ligament and anchored to the bone at the insertion site. For reconstruction: the graft is harvested — hamstring tendon, quadriceps tendon, or allograft — and prepared to the appropriate dimensions on the back table.
For reconstruction: the tibial and femoral tunnels are drilled at the anatomic PCL insertion sites. The graft is passed through the tunnels in the correct orientation and tensioned appropriately. For repair: the sutures are passed through bone tunnels or anchors and tied to restore ligament tension.
The graft or repaired ligament is fixed securely at both ends. Any associated ligament injuries — particularly posterolateral corner reconstruction if indicated — are addressed in the same session where planned. The portals are closed and a post-operative brace is applied.
Recovery after PCL surgery is generally more gradual than ACL recovery — since the PCL graft or repaired tissue operates under posterior tibial loading forces that require careful protection during the early phases. Hamstring strengthening is delayed specifically because the hamstrings create posterior tibial force, which stresses the healing PCL. At Ashirwad Hospital, recovery is planned and monitored through every stage by Dr. Chaudhari, not left to a disconnected physiotherapy provider.
Post-operative brace locked in extension. Crutches used. Quadriceps setting exercises begun immediately to prevent muscle atrophy without loading the PCL.
Wound review. Gradual increase in brace range of motion. Straight-leg raises and isometric quad activation. Swelling management with ice and elevation.
Progressive brace range-of-motion increase. Partial weight-bearing progressed as tolerated. Stationary bike started when flexion permits.
Brace weaned off. Full weight-bearing without crutches. Closed-chain quadriceps exercises progressed. Pool walking and swimming introduced.
Hamstring strengthening cautiously introduced in a protected range. Proprioceptive and balance training progressed. Light jogging when quad strength is adequate.
Follow-up review and functional assessment. Progression to more demanding strengthening. Most patients mobile and managing daily activities independently.
Running programme progresses. Sport-specific agility and deceleration drills introduced gradually. Strength symmetry testing performed.
Functional testing — posterior tibial sag assessment, strength symmetry, hop tests. Return to sport considered when objective criteria are met.
Full return to competitive sport for most patients following PCL reconstruction. PCL recovery is generally 3–6 months longer than ACL recovery due to the slower maturation of the posterior-positioned graft.
PCL injuries are less common than ACL tears — and this is exactly what makes clinical experience with this specific ligament valuable when choosing where to seek treatment. The following reflects common gaps patients describe when comparing hospitals for PCL care in Surat, and is meant to support an informed decision.
Specific clinical tests — the posterior drawer test, posterior sag sign, and dial test for posterolateral corner involvement — are performed at Ashirwad Hospital to accurately grade the PCL injury. Missing these tests is how PCL injuries are systematically underdiagnosed elsewhere.
PCL repair is considered at Ashirwad Hospital where the injury is caught early and the tissue is still viable — preserving the native ligament rather than defaulting to reconstruction in all cases. This option is only offered when the tissue is genuinely suitable, not as a shortcut.
Full knee evaluation — clinically and on MRI — identifies any associated ligament injuries at Ashirwad Hospital. Missing a concurrent posterolateral corner injury in a PCL reconstruction is one of the most significant causes of persistent instability and failure after PCL surgery.
PCL recovery is specifically paced for PCL healing — hamstring loading is deliberately delayed, posterior tibial protection is maintained longer, and the return-to-sport timeline is extended appropriately. This is different from the ACL rehabilitation protocol and patients who receive the wrong protocol risk graft failure.
Recovery at Ashirwad Hospital is planned and monitored by the same doctor who performed the surgery, with progress through each phase reviewed at follow-up appointments and adjustments made based on objective clinical findings.
A transparent discussion of what the estimated cost includes — surgeon fees, hospital charges, graft or suture materials, brace, and rehabilitation plan — happens at the consultation at Ashirwad Hospital before any booking is made.
A thorough first consultation is what ensures the PCL injury is correctly identified, graded, and treated — not assumed to be a minor knee sprain and sent home with rest alone. Here is what the first visit at Ashirwad Hospital covers:
A detailed discussion of how the injury happened, particularly any direct impact to the front of the shin — from a dashboard, a sports collision, or a fall directly onto the knee. The exact mechanism is important because it predicts the likely ligament pattern and associated injuries.
The posterior drawer test, posterior sag sign (Godfrey test), and quadriceps active test are performed to detect posterior laxity. The dial test is performed to assess posterolateral corner integrity. The overall range of motion, swelling, and neurovascular status of the limb are assessed.
MRI of the knee through the diagnostics and imaging centre at Ashirwad Hospital confirms the grade of PCL tear, identifies any associated posterolateral corner, ACL, collateral ligament, or meniscal injuries, and provides the imaging basis for the treatment plan. Patients who already have a recent MRI should bring the films or digital disc.
A clear explanation of whether rehabilitation, repair, or reconstruction is appropriate for your specific grade of injury and activity demands — with the reasoning explained rather than just the conclusion. The difference between repair and reconstruction is discussed where both options are clinically applicable.
A walkthrough of the procedure, graft or repair options, expected hospital stay, rehabilitation plan, and return-to-sport timeline. A transparent cost estimate based on your specific case, including what is and is not covered by your health insurance and what the rehabilitation will involve.
If you are searching for a PCL surgery doctor near me, or a knee ligament specialist near me in Surat, Ashirwad Hospital on L.P. Savani Road, Adajan is accessible to patients from across Surat and South Gujarat:
Dr. Ankit Chaudhari is an orthopedic surgeon at Ashirwad Hospital in Surat, with experience diagnosing and treating knee ligament injuries including the posterior cruciate ligament — which requires specific clinical tests to identify accurately and a tailored rehabilitation protocol that differs from the standard ACL recovery programme.
Because PCL injuries are graded differently from ACL tears, and because treatment can range from rest and rehabilitation to repair or full reconstruction depending on the grade, the diagnostic evaluation at Ashirwad Hospital is treated as the foundation of the entire treatment plan. For Dr. Chaudhari’s background and qualifications, visit the about us page, or check the orthopedic doctor near Surat with fees page.
PCL surgery at Ashirwad Hospital is part of a comprehensive knee and sports injury service covering all ligament, joint, and trauma conditions:
Accessible from Adajan, Vesu, Pal, Athwa, Katargam, Varachha, and across Surat city. Patients from Navsari, Bharuch, Tapi, and Valsad also travel to Ashirwad Hospital for PCL surgery and complex knee ligament care not available at local facilities.
| Monday – Saturday | 9:00 AM to 7:00 PM |
| Sunday | By prior appointment or emergency only |
No referral required. Visit the contact page to book your PCL consultation or check fees and availability.
Ashirwad Hospital provides specialized orthopedic care with modern facilities, expert surgeons, and patient-focused healing.
3rd Floor, Vision Business Hub Opposite Shell Petrol Pump, L.P. Savani Road, Adajan, Surat, 395009