DR. ONG KEE LEONG
Posterior Cruciate Ligament (PCL) Reconstruction
Posterior Cruciate Ligament (PCL) Reconstruction is a surgical procedure that repairs or replaces a torn posterior cruciate ligament in the knee. The PCL connects the thigh bone (femur) to the shin bone (tibia) and prevents the tibia from moving too far backward in relation to the femur. During reconstruction, the damaged ligament is replaced with a tissue graft that can come from the patient’s own body (autograft) or from a donor (allograft). The procedure aims to restore knee stability and function for patients with PCL injuries.
Book AppointmentPotential Risks and Complications
PCL reconstruction carries several potential risks. Infection can occur, marked by pain, redness, and fever, and requires prompt antibiotic treatment. Blood clots may form during immobilisation, but early movement can help prevent them. Graft failure is possible due to technical issues, inadequate rehabilitation, or new injuries, which may require revision surgery. Other complications include knee stiffness from scar tissue, persistent pain despite successful surgery, rare neurovascular damage causing numbness or circulation issues, and hardware irritation that may necessitate removal after healing.
Indications for PCL Reconstruction
PCL reconstruction may be recommended for patients who experience specific symptoms or conditions affecting knee stability and function.
- Complete PCL Tear: A complete tear of the PCL that causes knee instability. The ligament may be torn through sports injuries, falls, or traffic accidents where the front of the bent knee hits the dashboard.
- Failed Conservative Treatment: Patients who have undergone physical therapy, bracing, and activity modification without improvement. Non-surgical treatments typically require 3-6 months to determine effectiveness.
- Combined Ligament Injuries: PCL tears that occur alongside damage to other knee ligaments such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL). Multiple ligament injuries often require surgical intervention to restore knee stability.
- Chronic PCL Deficiency: Long-term PCL deficiency causing persistent symptoms and functional limitations. Ongoing instability may lead to cartilage damage and early arthritis if left untreated.
- High-Demand Activities: Patients who participate in activities requiring knee stability, such as sports or occupations with physical demands. Athletes and physically active individuals often require reconstruction to return to their previous level of function.
Surgical Techniques
- Arthroscopic Reconstruction: This minimally invasive technique uses small incisions and a camera to visualise and access the knee joint. The surgeon inserts an arthroscope and specialised instruments through 3-4 small incisions around the knee to remove the damaged ligament, drill tunnels in the femur and tibia, and place the graft. Arthroscopic techniques typically result in less post-operative pain and faster initial recovery compared to open surgery.
- Open Reconstruction: Traditional open surgery involves a larger incision to directly access the knee joint. This approach may be necessary for complex cases, revision surgeries, or when combined with other procedures. Open reconstruction provides direct visualisation of the knee structures but typically involves a longer recovery time and potentially more post-operative pain than arthroscopic methods.
Step-by-Step Procedure
Anaesthesia and Preparation
The patient receives general anaesthesia or regional nerve blocks administered through an IV line, sometimes with additional nerve blocks around the knee for post-operative pain management. Vital signs are continuously monitored throughout the procedure.
Diagnostic Arthroscopy
The surgeon performs an initial examination of the knee joint by inserting an arthroscope through a small portal to visualise the PCL tear and evaluate cartilage, menisci, and other ligaments, identifying any additional injuries requiring treatment.
Graft Harvesting and Preparation
For autografts, tissue is harvested from the patient’s patellar tendon, hamstring tendons, or quadriceps tendon through an incision at the donor site, then prepared to the appropriate size and length. For allografts, pre-prepared donor tissue is measured and prepared.
Tunnel Creation and Graft Placement
Precise tunnels are drilled in the femur and tibia using specialised guides to match natural PCL attachment points. The prepared graft is then carefully threaded through these tunnels using passing sutures and specialised instruments.
Fixation and Closure
The graft is secured at both ends using screws, buttons, or other fixation devices and tensioned appropriately. The surgeon tests knee stability and range of motion, addresses any remaining issues, then closes arthroscopic portals and incisions with sutures or staples before applying dressings.
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For Singaporeans & Singapore Permanent Residents
Preparing for Surgery
- Medical Evaluation: A thorough assessment determines suitability for surgery and identifies potential risks. This typically includes a physical examination, imaging studies (MRI, X-rays), and laboratory tests to evaluate overall health status and rule out conditions that may complicate surgery or recovery.
- Medication Adjustments: Certain medications may need to be temporarily discontinued before surgery. Blood thinners, anti-inflammatory medications, and herbal supplements that can increase bleeding risk should be stopped 7-10 days before surgery.
- Fasting Guidelines: Patients must follow specific pre-surgical fasting instructions. Typically, no food should be consumed for 8 hours before surgery, though clear liquids may be permitted up to 2 hours prior to the procedure.
Post-Surgical Care and Recovery
- Immediate Care and Pain Management: Patients typically stay in the hospital for 1-2 days with monitoring and initial mobility exercises. Pain management includes medication, ice therapy, elevation, and compression. A special hinged and tensioned knee brace is worn for 6 weeks, with gradual adjustment as healing progresses.
- Rehabilitation: Rehabilitation spans 12 months in distinct phases: early (weeks 1-6) focuses on protection and motion; intermediate (weeks 6-12) on strength and gait; advanced (months 3-6) on functional exercises; and the final phase on power and agility before a full return to activities.
- Follow-up and Return to Activities: Regular assessments occur at 2 weeks, 6 weeks, 3 months, 6 months and 12 months. Return to activities is gradual, typically: desk work (1-2 weeks), driving (6-8 weeks), light duties (3 months), and heavy labour (6 months). Sports resumption begins with low-impact activities (4-5 months), progressing to limited sport-specific training (6-9 months) and full competition (12 months).
Benefits of PCL Reconstruction
Restored Knee Stability
Surgery re-establishes proper knee mechanics by replacing the damaged PCL. Patients typically experience reduced giving-way episodes during walking, running, and pivoting movements.
Prevention of Secondary Damage
Reconstruction helps protect the knee from further injuries to cartilage and other structures. Untreated PCL injuries can lead to progressive joint degeneration and early-onset arthritis.
Pain Reduction
The procedure addresses the source of knee pain by restoring proper alignment and function. Many patients report significant pain relief following successful rehabilitation.
Return to Activities
Patients can often resume sports and daily activities that were limited by the PCL injury. Most individuals return to pre-injury activity levels 12 months after surgery and rehabilitation.
Long-term Joint Preservation
By restoring normal knee biomechanics, reconstruction may help extend the life of the knee joint. Proper ligament function reduces abnormal stress on cartilage surfaces and other knee structures.
Why Do Patients Choose Dr Ong Kee Leong?
- Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
- Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
- Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
- Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
- Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
- Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
- Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
- Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park Hospital
- Minimal Waiting Time For Initial Consultation
- Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)
About Dr. Ong Kee Leong
Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)
Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.
He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.
- MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
- Member of the Royal College of Surgeons of Edinburgh 2007
- Master of Medicine in Orthopaedic Surgery (NUS) 2007
- Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
- Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
- Sports Surgery and Arthroscopy in Germany (Hannover)
- Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
- Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
- Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
- He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
- Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
- He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.
Frequently Asked Questions
How long will my PCL graft take to heal completely?
The graft healing process occurs gradually over time. Initially, the tendon graft undergoes “ligamentisation” – transforming into ligament-like tissue, which involves a period of weakening before strengthening. Complete biological maturation takes about 12-18 months, though you will typically achieve functional stability much earlier.
Will I need a second surgery to remove hardware used during PCL reconstruction?
Most modern fixation devices (screws, buttons, pins) remain permanently in place without causing problems. A small number of patients may experience irritation from hardware and may require a minor procedure for removal. This would typically be performed after the graft has fully healed, usually at least 12 months after reconstruction.
Can PCL tears heal without surgery?
Some isolated PCL injuries with partial tears can heal with non-surgical treatment. Mild and some moderate tears often respond well to bracing and physical therapy, particularly in less active individuals. However, complete tears, combined ligament injuries, or PCL injuries in highly active people typically have better outcomes with surgical reconstruction.
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Mt Elizabeth Novena
- 38 Irrawaddy Road #06-59/60/61 Mt Elizabeth Novena Specialist Centre Singapore 329563
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
other practice locations
Farrer Park Hospital
- 1 Farrer Park Station Road #14-06 Connexion Singapore 217562
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
-
Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
Mt Alvernia Medical Centre
- 820 Thomson Road #07-53 Mt Alvernia Medical Centre D Singapore 574623
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."
Billing & Payment
Consultation fees are charged based on length of consultation, and start from SGD$200 (within 30 minutes).
Modes of Payment
We accept the following modes of payment:
- Cash
- PayNow & PayLah
- All major Credit Cards
If you are insured and would like to use a Letter of Guarantee (LOG) from the major insurers in Singapore, please contact us and our friendly clinic staff will assist you and provide more information if required.
Can I Claim Through My Medisave Account? (For Singaporeans and PR)
Yes, you can. Our Clinic is an accredited day surgery clinic by the Ministry of Health. Singaporeans and Permanent Residents may use their Medisave for eligible orthopaedic inpatient procedures and hospitalizations.
The exact amount would depend on the complexity of the procedure. If you have any enquiries, feel free to speak to our friendly clinic staff about using your Medisave account.
Integrated Shield Plans (Singaporeans and PRs)
Yes, patients who have purchased Integrated Shield plans with riders for co-insurance and deductibles will be able to use them in our clinic for eligible procedures. For more information, contact us to find out if your procedure is claimable.
The 5 Approved Integrated Shield Insurers are:
- NTUC Income’s IncomeShield and Enhanced IncomeShield
- American International Assurance International Co’s (AIA) HealthShield Gold
- Great Eastern Life Assurance Co’s SupremeHealth and SupremeHealth Plus
- Prudential Assurance Co’s PRUShield
- AXA Shield