Posterior Cruciate Ligament (PCL) Injuries: How Athletes Like Bo Bichette Can Return Without Surgery

Posted on: October 28th, 2025 by Our Team

When most people think of knee ligament injuries in athletes, they immediately think of the ACL. However, the posterior cruciate ligament (PCL) is another important stabilizing ligament in the knee that can be injured during sports. Recently, Bo Bichette of the Toronto Blue Jays sustained a PCL sprain after colliding with Yankees catch Austin Wells, yet was able to return to play in the World Series after nonsurgical treatment. His case highlights an important point: not all knee ligament injuries require surgery.

Understanding the role of the PCL and how these injuries are treated can help athletes make informed decisions if they experience similar knee injuries.

What Is the Posterior Cruciate Ligament?

The knee contains four primary stabilizing ligaments:

• ACL (anterior cruciate ligament)
• PCL (posterior cruciate ligament)
• MCL (medial collateral ligament)
• LCL (lateral collateral ligament)

The PCL sits deep within the knee joint and connects the femur (thigh bone) to the tibia (shin bone). Its primary function is to prevent the tibia from moving too far backward relative to the femur.

In many ways, the PCL acts as the primary restraint to posterior translation of the tibia, particularly when the knee is flexed.

How Do PCL Injuries Occur?

PCL injuries typically occur when a direct force drives the tibia backward while the knee is bent.

Common mechanisms include:

• A fall directly onto a flexed knee
• A dashboard-type injury in a car accident
• A collision in sports where the front of the knee is struck

In baseball, these injuries can occur during slides into bases or awkward falls while fielding or running the bases.

Symptoms of a PCL Injury

Compared with ACL injuries, PCL injuries are often less dramatic initially.

Athletes may notice:

• Posterior knee pain
• Swelling
• A sense of instability when descending stairs or running downhill
• Difficulty with explosive movements

Some athletes can continue playing initially, which can delay diagnosis.

Why Many PCL Injuries Do Not Require Surgery

One of the unique features of the PCL is its relatively good ability to heal with nonsurgical treatment.

For low-grade sprains (Grade I or II) and even some high-grade sprains (Grade III), treatment typically includes:

• Temporary activity modification
• Physical therapy
• Quadriceps strengthening
• Bracing in some cases

A strong quadriceps muscle helps prevent posterior tibial translation, compensating for PCL laxity.

This is why many professional athletes—including Bichette—can successfully return to sport without surgery after a PCL sprain.

When Is Surgery Necessary?

Surgery may be recommended when:

• There is a complete PCL tear with persistent instability
• The injury occurs with other ligament injuries (multiligament knee injury)
• There is significant functional limitation despite rehabilitation

In these cases, PCL reconstruction may be required to restore stability.

Recovery and Return to Play

Recovery timelines depend on the severity of injury.

Typical timelines include:

• Grade I sprain: 2–4 weeks
• Grade II sprain: 4–8 weeks
• Complete tears: longer rehabilitation or surgical treatment

Professional athletes often return sooner because they have access to daily rehabilitation and advanced medical care, but the same principles apply to recreational athletes.

Key Takeaways

PCL injuries are less common than ACL injuries, but they are still important to recognize—especially in athletes.

The good news is that many PCL injuries can be treated successfully without surgery, allowing athletes to return to their sport with appropriate rehabilitation.

If you experience persistent knee pain, swelling, or instability after a sports injury, evaluation by a sports medicine specialist can help determine the best treatment plan for a safe return to activity.