Madhuram Physiotherapy clinic

13/12/2025

09/12/2025

📍 Introduction

The Posterior Cruciate Ligament (PCL) is one of the two cruciate ligaments of the knee.
It is stronger, shorter, and less oblique compared to the ACL.
It prevents the posterior displacement of tibia relative to femur.

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📌 Origin & Insertion (Anatomical Points)

🔹 Origin
• Posterior intercondylar area of tibia
(Just below posterior tibial plateau)

🔹 Insertion
• Lateral surface of medial femoral condyle
(Inside the intercondylar notch)

📘 Note: Fibres run upwards, forwards, and medially.

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📐 Orientation
• Upward
• Forward
• Medial

This direction helps PCL create a cross with the ACL → forming the “cruciate” arrangement.

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📏 Length & Strength
• Approx 38 mm long
• Stronger than ACL (almost twice)
• Primary stabilizer against posterior movement of tibia

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📂 Parts of PCL
1. Anterolateral bundle
• Larger & stronger
• Tight in flexion
2. Posteromedial bundle
• Smaller
• Tight in extension

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🩺 Functions

Primary Function
• Prevents posterior translation of tibia on femur
(Especially when knee is flexed)

Secondary Functions
• Helps prevent:
• Varus stress
• Valgus stress
• Hyperextension
• Supports femoral rollback in flexion

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🦵 Biomechanics
• PCL is tight in full flexion
• Guides normal roll-and-glide movement of femur on tibia
• Works with ACL to maintain central axis of rotation
• Important in descending stairs, squats, running downhill

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🔍 Blood Supply
• Branches of middle genicular artery

⚡ Nerve Supply
• Tibial nerve (via branches to capsule & ligaments)

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🩹 Mechanism of Injury (MOI)
• Dashboard injury (tibia pushed backward)
• Hyperflexion
• Fall on flexed knee
• Sports: football, wrestling, kabaddi

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🧪 Clinical Tests

1️⃣ Posterior Drawer Test
• Most specific
• Tibia moves posteriorly

2️⃣ Sag Sign
• Tibial tuberosity “drops back” when knee flexed at 90°

3️⃣ Quadriceps Active Test

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🚑 Symptoms of PCL Injury
• Pain in deep knee
• Difficulty in squatting, descending stairs
• Mild swelling
• Instability (less than ACL)

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📷 Radiology
• MRI: gold standard
• Shows fibre disruption or avulsion

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🛠️ Management

Conservative
• Grade I–II:
• Brace
• Physiotherapy (strengthening quadriceps, avoiding hamstring overload)

Surgical
• Grade III or combined ligament injury
• PCL reconstruction

05/12/2025

🦵 ACL (Anterior Cruciate Ligament) – Detailed Anatomy (BD Chaurasia Style)

⭐ Introduction

The ACL is one of the two cruciate ligaments inside the knee joint (ACL + PCL).
It is a strong intracapsular but extrasynovial ligament that provides anterior stability to the knee.

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📍 Origin & Insertion (Attachments)

🔸 Origin (Tibial Attachment)
• Arises from the anterior intercondylar area of the tibia
• Lies just in front of the tibial spine
• Slightly blends with the anterior horn of the medial meniscus

🔸 Insertion (Femoral Attachment)
• Runs upwards, backwards & laterally
• Attaches to the posterior part of the medial surface of the lateral femoral condyle
(inside the intercondylar notch)

✨ Remember: ACL → from tibia to femur (A → P direction)
🧬 Direction of Fibers
• Upward, backward, and lateral
• Twisted in the middle
• Tight in extension → the knee gets stability
• Relatively lax in flexion

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🧩 Structure

ACL has two bundles:
1. Anteromedial (AM) bundle
– Tight in flexion
– Primarily controls anterior tibial translation
2. Posterolateral (PL) bundle
– Tight in extension
– Controls rotational stability

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🩺 Functions of ACL

1️⃣ Prevents anterior translation of tibia

Stops the tibia from sliding forward under the femur.

2️⃣ Controls rotational stability

Especially during cutting, pivoting, and twisting movements.

3️⃣ Guides screw-home mechanism
• Helps in the terminal locking of the knee during extension.

4️⃣ Provides proprioception

Contains mechanoreceptors → helps with joint position sense.
🧪 Blood Supply
• Mainly from the middle genicular artery
• Poor vascularity → slow healing, poor natural repair → common reason for surgical reconstruction.

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🧠 Nerve Supply
• Branches from the posterior articular nerve (from tibial nerve)
• Contains mechanoreceptors for proprioception.

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⚠️ Mechanism of Injury (Important for physio & orthopedics)

Most common:
• Non-contact twisting injury
• Sudden deceleration / cutting / pivoting
• Valgus + external rotation force
• During sports: football, basketball, kabaddi, badminton

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🧪 Clinical Features
• Sudden pop sound
• Immediate pain + swelling (hemarthrosis)
• Feeling of instability / knee giving way
• Difficulty in weight bearing

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🧫 Clinical Tests

1️⃣ Lachman Test → most sensitive
• Tests anterior tibial translation at 20–30° flexion

2️⃣ Anterior Drawer Test (90° flexion)

3️⃣ Pivot Shift Test → tests rotational instability

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🖼️ Imaging
• MRI = gold standard
Shows fiber discontinuity, bone bruise (lateral femoral condyle + tibial plateau).

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🛠️ Management Overview

Conservative
• Mild sprains / low-demand patients
• Strengthening: quadriceps, hamstrings, neuromuscular training

Surgical (ACL Reconstruction)
• Grafts used: Hamstring tendon, Patellar tendon (BTB), Quadriceps tendon
• Post-op rehab:
• Early ROM
• Strengthening
• Proprioception
• Return to sport at ~8–12 months

04/12/2025

🔹 1️⃣ Femur (Thigh Bone)
• Longest & strongest bone in the body
• Lower end forms medial & lateral condyles
• These condyles articulate with tibia
• Has patellar groove (trochlea) where the kneecap glides
• Provides major weight-bearing support

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🔹 2️⃣ Tibia (Shin Bone)
• Main weight-bearing bone of the leg
• Upper end has tibial plateau with two surfaces:
• Medial condyle – larger, bears more weight
• Lateral condyle – smaller
• Has intercondylar eminence for ligament attachments
• Forms the main hinge with femur

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🔹 3️⃣ Patella (Kneecap)
• Largest sesamoid bone
• Lies inside the quadriceps tendon
• Improves lever arm → increases thigh muscle efficiency
• Protects the knee joint
• Slides in the femoral groove

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🔹 4️⃣ Fibula (Side Bone of Leg)
• Does not bear body weight
• Provides stability to ankle
• Serves as attachment for key knee ligaments
• Important for lateral knee support

01/12/2025

KNEE JOINT ANATOMY
“The most important weight-bearing joint of your body.”

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🔹 Slide 2: What is the Knee Joint?

The knee is a hinge-type synovial joint that helps in:
✔ Walking
✔ Running
✔ Sitting
✔ Standing
✔ Jumping

It allows flexion, extension and slight rotation.

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🔹 Slide 3: Bones Involved

The knee joint is formed by 3 main bones:
1️⃣ Femur – Thigh bone
2️⃣ Tibia – Shin bone
3️⃣ Patella – Kneecap (protects the joint)

(You can add simple bone icons.)

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🔹 Slide 4: Cartilage (Smooth Cushion)

Knee has articular cartilage that:
✔ Reduces friction
✔ Helps smooth movement
✔ Absorbs shock

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🔹 Slide 5: Meniscus (Shock Absorber)

Two C-shaped pads:
• Medial meniscus
• Lateral meniscus
Functions:
✔ Distribute weight
✔ Improve stability
✔ Protect cartilage

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🔹 Slide 6: Ligaments (Stability)

Main 4 ligaments of the knee:
🔸 ACL – Prevents forward movement of tibia
🔸 PCL – Prevents backward movement
🔸 MCL – Inner side stability
🔸 LCL – Outer side stability

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🔹 Slide 7: Muscles (Movement)

Key muscle groups:
💪 Quadriceps – Straighten the knee
💪 Hamstrings – Bend the knee
💪 Calf muscles – Support and stability

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🔹 Slide 8: Bursa (Fluid Bags)

Small fluid-filled sacs that:
✔ Reduce friction
✔ Allow smooth movement

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