[Fultonius]

Was in a car accident a week ago (more on that at a later date) and the dashboard crushced my right leg a bit. Just been to the physio and he's 80% sure I've torn my posterior cruciate ligament (PCL). (as in completely, ripped, shredded, nothing left)

Got a consulatation with a knee specialist (Colin Walker) and no doubt an MRI will be called for.

Anyone done this beofre, or heard of it? Google & physio both don't think I'll get surgery so I'll just have to rehab it like mad and see what happens.

I'm thinking the uncontrolled action of falling of boulders may mean I have to give it up for good :-( So just trad/winter and sport left...

Any thoughts? 

[Krank]

Ive done this, not quite as bad, mine was about 50% torn, but it got replaced anyway. They took the replacement ligament from the front of my other knee. It is not 100% now however i was in a rave about a month afterwards giving it some (i know this was very stupid). I think if you do the rehab properly and stay away from highballs then you will be fine to continue bouldering. I tweak mine now and again but only when falling from a height. I would be quite hopefull of a good recovery if you are sensible. Good luck with it.

Make sure you get an MRI, i dont care how good a doc is they cant see inside your knee.

[GCW]

PCLs are over-rated, you don't really need them.
And there's no good evidence that PCL recon improves function*.



*assuming it's an isolated PCL.

[SA Chris]

Any thoughts?

Bummer,

That you are rivalling Paul B in the Unluckly Alf stakes.

I shall now refer to you as Prone.

Hope it gets sorted.

[Fultonius]

PCLs are over-rated, you don't really need them.
And there's no good evidence that PCL recon improves function*.



*assuming it's an isolated PCL.

So, heel-hooking, snowboarding, mountainbiking etc should all be OK without one?

I'm guessing I've booked myslef a seat on the one-way train to osteo-arthritis of the knee?

[Fultonius]

P.S. - If it's a PCL rupture and they chose not to go for surgery, what's the usual timescale for recovery? 3-6 months?

[GCW]

PCL isn't hugely important for knee stability if all other structures (ACL, MCL, LCL, PLC etc) are intact, and it's pretty easy to retrain to use alternative stabilisers.  There is some evidence that isolated PCL rupture can lead to OA of the patellofemoral and medial joints, and many people feel this is a reason to reconstruct early in younger patients.

Not being disparaging towards your physio, but there's quite a few things to look for in the knee (I don't know if they are a knee specialist or not).  Is there a haemarthosis, for example (Knee is like a balloon), the abscence of which goes against the diagnosis to a degree.

One thing that's vital to remember is that a true knee injury can be very hard to assess in the acute phase.  As an aside, I often didn't bother with MR for things like ACL injuries either, if we were fairly confident we'd just do a scope with a view to recon if we confirmed it. 

My advice is the usual- see someone that knows.  Good luck.  After assessment they may feel reconstruction is appropriate, but it goes very much on what they find when they twist your knee out of shape.

[Fultonius]

The physio is fairly well versed with knees. (He's part of thwe Glasgow Sports Surgery).

What he actually said was -

It appears that you have most likely torn your PCL. You are in the wrong place, go and see a specialist knee orthopeadic consultant asap.

I've already booked an appointment with the knee specialist. Have you any knowledge of this bloke?

http://www.gsss.co.uk/surgeons.php?page=Colin+Walker+-+Knee

[GCW]

I never worked at Southern when I was up your way.  Besides, I couldn't possibly comment anyway

I'm sure you'll be fine whichever way it goes.

[duncan]

Commiserations. 

I did my left PCL nine months ago.  MRI confirmed it but the diagnosis was pretty clear from clinical examination.  Luckily no other structures were damaged and there wasn't a huge amount of swelling.

I started exercises directed by a physiotherapist about 10 days after, once the pain had settled, working on balance/proprioception and quads. strengthening and speed of contraction.   

I was trad. climbing a month after injury at much the same standard as before (E1).  Two months after the injury I climbed my first E3 in five years.  It took longer to feel confident about jumping off from any height and I'm still slightly nervous about this.  I've never been very bouncy though and I made less effort to work on this than might someone more dedicated to bouldering.  Heel-hooking was the biggest problem and it took four or five months to 'learn' to contract my quads. to counteract hamstrings' pull on the tibia.  Even subtle hooks around an arete were painful at the stage when I could charge up and down hill with no problems at all.

[slackline]

Car crash sounds nasty, glad you're semi-okay.

[Fultonius]

Car crash sounds nasty, glad you're semi-okay.

Cheers, it was!

GCW - how much (roughly) would a PCL recon cost if done privately? I don't have insurance... I guess the NHS just don't bother doing them unless absolutely necessary?

P.S. Three A&E doctors missed my torn PCL - fair enough with the first guy, he was just patching me up, but the second two doctors that I saw when I went in to complain about an unstable knee showing clear signs of a PCL problem didn't even mention the possibility!

[GCW]

if you're having symptoms of instability it sounds more likely you'll need something doing, but as I say it partly depends on PLC etc stability as to what exactly is required.
There's a fair bit of rehab to be done after any reconstruction, which you may want to factor into costs.  For the consultation/surgery/stay you'd be looking at a ball park £5000 I would suspect, depending on your provider.  Waits on the NHS aren't too bad at present so it'd be worth checking.

I guess the NHS just don't bother doing them unless absolutely necessary?

That shouldn't be the case, if it needs doing it needs doing.  And don't forget nearly all the consultants in the private field work in the NHS too, so you would hope the opinion would be the same.  It isn't as simple as saying "it's broken therefore fix it", it will depend on risk:benefit.

[Fultonius]

Cool, cheers for the info. You're right, Colin works for both the NHS and private and I'm sure his skills don't get worse just because he's working in a different hospital 

The reason I'm asking about the cost is there's a very slight possibility that getting me back to work ASAP may mean it's worth my company paying for the treatment (if I'm very lucky) and also, if they can't, and it turns out I need to go private for whatever reason, I might not buy a similar quality replacement car and use the money to get myself fixed up!

I can tell you, I'd rather have a solid knee than a nice car.

[Fultonius]

Well, it's confirmed: Completely torn my PCL and am "Very Likely" to have done some other damage to my PLC and cartlidge.

99% outcome will be full reconstructive surgery!

 

It will be fixed: I will be out the game for 6 months at least!

[GCW]

Bad luck.
All about the old PLC, something many people don't realise. 
Don't mean to be negative, but I think 6 months is a bit optimistic to be getting back to your game.  I hope you manage though.

[Fultonius]

Optimism will keep the motivation up...

As an aside, what are your thoughts on using hyperbaric oxygen post-surgery to improve recovery?

[GCW]

Apart from finding a chamber to use, you'd look like a right Michael Jackson. 

I can understand the idea of it, but I can't see it being any better than just cracking on with rehab.  Why, have they offered you it privately?

[Fultonius]

Nah, my dad's got one of the only home tubes in britain - he's got rheumatoid arthritis and associated lung problems and has helped loads. (i.e. he's only on 5mg/day of steroids and no other drugs, but has stabilised for about 3 years, depsite the fact the doctors gave him 2 week to live almost 4 years ago)

I was using it straight after the crash (well, I actually used the MS one in Dundee) but it seems to have helped reduce the swelling a lot (clearly, I have nothing to compare against, so might be no better than placebo, but my occy health doctor assumed bmy injury was old due to the fact there was very little swelling 10 days after the accident - it was like a fecking baloon for 5 days!!!)

I don't use the same doctor as Michael Jackson, so I should alright 

[Fultonius]

Time for an update:

Been for an MRI:


Diagnosis was: Complex picture.
1. High grade PCL tear confirmed. ACL intact.
2. Areas of bone bruising as described.
3. With reference to posterolateral corner: definite
posterolateral corner injury involving biceps femoris, LCL,... See more
popliteus tendon and popliteofibular ligament. However most
of these structures appear to have partial tears rather than
complete disruption. Posterolateral corner capsular rupture
with soft tissue oedema.

Should be getting surgery on the NHS within a couple o months. 

[GCW]

Have fun, it's a very satisfying procedure*



*to perform, at least.  All the best with it though.

[Fultonius]

Damn, those pics haven't worked...grrr!!!

So you like drilling, cutting and screwing people back together then 

Surgeon _{unfortunately} agreed with you - probs 12 months before climbing again. 

[GCW]

So you like drilling, cutting and screwing people back together then 

Not any more.

[Fultonius]

Surgery on th 10th of May, then 6 weeks in a locked knee brace. it's going to be  with maybe some  and not a lot of 

So, 10th of May 2011 is the next time I can climb, give or take a few months either way. 

[magpie]

At least you've got a date soted for the surgery and the end is in sight, even if it is a while off yet.  If you get really bored while you have your brace on I will play Scrabble with you on Facebook*.   

*not a euphemism

[Serpico]

  If you get really bored while you have your brace on I will play Scrabble with you on Facebook*.   

*not a euphemism

Urban Dictionary suggests otherwise:
http://www.urbandictionary.com/define.php?term=scrabble

[hairich]

jamie big hands did the nose wearing his knee brace.you will be fine.my wife had surgery on both knees today she is a legend

[Fultonius]

Scrabble, ps3, bluray and chin ups - that's my life for the next month or so 
Is that:

jamie big hands did the nose wearing his knee brace.you will be fine.my wife had surgery on both knees, today she is a legend

Or has she had surgery on both knees today?

Punctuation, get some!

[Fultonius]

Rich, how's your wife doing?

Not long now, only another 5 days. I've started up a rehab blog, probably mostly uninteresting, but for anyone else who's likely to be going for the same surgery it might be helpful.
http://pcl-rehab.blogspot.com/]
[url]http://pcl-rehab.blogspot.com/[/url]

[SA Chris]

ou sroted out your games console probs yet?

[Fultonius]

Aye, just took it back and got my money back, then went and bought another one. Need to get some more games though.

[hamsforlegs]

Sorry to resurrect this old thread (particularly as I'm basically a lurker round here), but I've just ruptured my PCL  and wondered if any previous posters or others could give me a few hints based on their own experiences?

I'm currently living in Canada (probably until summer 2013), so will likely try to rehab without surgery if I will be able to do some hiking, climbing and skiing in that time, as surgery would mean waiting and recovering when I want to be exploring! I've had an MRI and seen a consultant and he thought this was a sensible plan. Of those who didn't have surgery, I just wondered what limitations you found in the medium term? Heel-hooking I can see would be tricky. What about running and/or hiking? How quickly did you manage to get back to days out on rough ground or to bouldering?

Fultonius: your blog and posts have been one of the few places of detailed information of any use that I can find. Much kudos for putting it all out there. On return to the UK I may well seek surgery in the interests of long term health and function. Did you get treated on the NHS in the end? I can see that you worked hard and have got to a good position with it, which is inspiring.

Cheers all for any anecdotes. SCIENCE is great too, but understand that it's not necessarily what I'm after here 

[Fultonius]

Just in Geneva airport, on the way back from 3 days of powder in chamonix! Yyfy!

Just for a bit of inspiration,  that's at least 50 ski days this year and not too many knee issues.

It's a major operation, so, I reckon give it a shot without surgery,  but if it feels unstable then you'll probably need surgery asap. Give me a pm if you want any more info.

P. S.  How did you do it? Like gcw said above,  are you sure it a *just* the pcl?

[duncan]

Sorry to resurrect this old thread (particularly as I'm basically a lurker round here), but I've just ruptured my PCL  and wondered if any previous posters or others could give me a few hints based on their own experiences?

I'm currently living in Canada (probably until summer 2013), so will likely try to rehab without surgery if I will be able to do some hiking, climbing and skiing in that time, as surgery would mean waiting and recovering when I want to be exploring! I've had an MRI and seen a consultant and he thought this was a sensible plan.

It's nearly 3 years since I did my left PCL and now the knee basically feels fine for rock climbing and running.  I chose not to have surgery, worked hard rehab.ing my knee for about 4-5 months and have been doing stuff intermittently since then.  My L. quads are still a bit weaker than R. but I am R. footed and I don't know how much difference there was pre-injury.  I should do more L. quads. strengthening work.  I can do a full single-leg squat with either leg, so I'm not completely feeble.

Science says that following surgical ligament repair, the muscles and balance are by no means as good as an uninjured knee even in those who have had quite extensive physio./rehabilitation.  There is very little science specific to PCLs.  The long-term outcomes of surgery are quite good but people who don't have surgery also do quite well (if the PCL only injured). 

[hamsforlegs]

Fultonius, Duncan, really appreciate your input.

Mine was ruptured in a skiing fall. Very unusual. I have a total (or near enough to make no difference) rupture of the PCL, and a grade 2 tear of the MCL. I saw a good sports orthopod who thought that the MCL should heal without major issues; it seems to be doing well and is only bothered by twisting into drop-knee positions now. All the other structures of the knee were assessed as intact and stable.

I've been working with a knowledgeable kinesiologist/strength-coach to get back to good movement and durability, so the rehab side is taken care of as well as it can be for the moment. Running is also coming along OK. I walk most downhill at the moment, but find any kind of sustained downhill leaves me with a dull ache that makes me worry about the long term impact.

Duncan; it was interesting to hear that you have been OK with climbing and running. Thanks for the links. I think I already had that picture from my own reading, but that's some good information. It's great to hear that function can be reasonable without surgery. I guess my concern is about long term health, and whether it is worth pursuing the surgery for the chance that it will improve long-term outcomes. It all seems pretty uncertain.

Fultonius; great to hear that you had a good ski season! This was my first, and I probably had about 30-40 days before getting injured. I'd like to do some touring next season, so we'll see how the rehab goes...

Thanks both!

[duncan]

I guess my concern is about long term health, and whether it is worth pursuing the surgery for the chance that it will improve long-term outcomes. It all seems pretty uncertain.

That's the crucial question isn't it?  I have no idea as to the answer.  My uninformed view is that surgery might improve long-term outcomes but we don't know for sure and, as always, there is a slight risk of a much worse outcome.  Because I was managing fuctionally I decided against opting for a theoretical and currently unproven (I think) benefit.  Unfortunately, I wont know for another 20 years if it was a good decision for me!

[hamsforlegs]

Duncan, you're completely right in the short/medium term.

My concern is that I've read a lot of accounts suggesting that the problems of going without the surgery often rear their heads within 3-5 years in active people, rather than holding out for 15-20. By the time you start having pain/issues, the osteo is already well established. Hmmm.

I'll be keeping my eye on the state of the surgical art I think - I share the view that doing no harm through a botched op has a lot gong for it, but if they get more confident about the outcomes it seems pretty inviting?