My knee still feels loose and sags backwards years after a PCL injury. Is surgery still an option?

What people with an old PCL tear notice

Many describe a knee that is fine on flat ground but feels vague going downstairs, slowing down or walking downhill. Others notice aching at the front of the knee after long days, or a visible dip below the kneecap when the knee is bent. Some have adapted well for years and only notice problems when they become more active or gain weight.

Before thinking about surgery

A dedicated quadriceps programme can make a real difference even years after the injury, and is usually tried or optimised first. If symptoms persist, Dr. Gelber looks for the reasons the knee is still loose:

• A posterolateral corner injury that was not treated, which often needs reconstructing at the same time
• Leg alignment and the slope of the top of the tibia, as a flatter slope increases backward sag
• The state of the cartilage behind the kneecap and on the inner side of the knee
• How far the shin moves backwards, often measured with stress X-rays

What reconstruction involves in chronic cases

The torn PCL is replaced with a tendon graft, from your own leg or a donor. In chronic cases, other procedures may be combined, such as reconstructing the posterolateral corner or, in selected knees, an osteotomy that changes the slope or alignment of the tibia. The aim is to restore more normal mechanics and stability rather than to make an old knee new.

Realistic expectations

Reconstruction usually improves stability, and many patients notice easier stairs and more confidence. It does not reverse existing cartilage wear, so if arthritis is already advanced, pain may persist and other treatments may be more suitable. Dr. Gelber discusses what can realistically improve for your knee before you decide.