16/07/2026
PCL Tear: Rehab or Surgery? This X-ray can change the entire treatment plan.
Most patients get an MRI, see a PCL tear, and immediately ask, “Do I need surgery?”
The answer is not based on the MRI alone.
One of the most important investigations in a PCL injury is the kneeling stress view X-ray.
What does the kneeling stress view tell us?
It measures posterior tibial translation (PTT)—how far the tibia shifts backward under load compared to the opposite knee.
This tells us the functional instability of your knee.
How do we interpret it?
➡️ < 8 mm side-to-side difference
* Usually suggests an isolated PCL injury.
* If symptoms are manageable, structured rehabilitation is often the first choice.
➡️ 8–12 mm difference
* Suggests a higher-grade PCL injury.
* Treatment depends on symptoms, activity level, and clinical examination.
* Surgery may be considered if instability persists despite rehabilitation.
➡️ > 12 mm difference
* Raises suspicion for a combined ligament injury (PLC or other ligaments) rather than an isolated PCL tear.
* Further evaluation is essential because simply reconstructing the PCL may not be enough.
Why is this X-ray so important?
✅ It quantifies instability objectively.
✅ It helps determine whether rehabilitation is likely to succeed.
✅ It helps identify hidden combined ligament injuries.
✅ It guides surgical planning—whether an isolated PCL reconstruction is sufficient or whether combined ligament reconstruction is needed.
Remember:
❌ MRI shows what is torn.
✅ Kneeling stress view X-ray shows how unstable your knee is.
And in PCL injuries, we treat instability—not just the MRI report.