Can children and teenagers tear their PCL, and how is it treated?

How the injury differs in young people

In growing bones, the attachment point of the PCL can be weaker than the ligament itself. A fall onto a bent knee in football, basketball or a playground accident can therefore cause an avulsion fracture, where the ligament stays intact but takes a fragment of bone with it. Older teenagers whose growth plates are closing tend to injure the ligament itself, as adults do.

Symptoms to look out for

• Pain at the back of the knee after a fall or a blow to the front of the shin
• Swelling, sometimes significant if there is a fracture
• Difficulty fully straightening or bending the knee
• A limp or reluctance to put weight on the leg
• Unsteadiness going downstairs once the pain settles

Diagnosis and treatment

X-rays usually show an avulsion fragment, and MRI shows the ligament, the growth plates and any other injury. A fragment that has not moved may be treated in a brace or cast with close follow-up. A displaced fragment is often fixed back with small screws or stitches through keyhole or open surgery, with care to protect the growth plates, and this usually restores stability well. A mid-substance tear is commonly treated with a PCL brace and a rehabilitation programme.

Returning to sport and school

Children often feel better before healing is complete. Return to sport is guided by healing on X-ray, strength and control tests. At Aman Hospital in Doha, Dr. Gelber examines the child, reviews imaging with the family and plans treatment around growth, school and sport.