Wednesday, June 19, 2013

Melissa The Soccer Player

Hello and welcome to my blog. 
Melissa is asking for help. 
Please read her story and leave comments.

Thanks,
Skinnygurl





On June 11, 2012 I blew my PCL out during a coed soccer game. I went into a challenge with a guy on the other team and he nailed me, cleats up, straight in the knee. I felt an intense burning sensation. and what I can best describe as feeling like my knee bent the wrong way.
A trip to the ER resulted in a diagnosis of no tears, just some strain from the hyper-extension. I got an appointment with an orthopedist and a manual exam and MRI confirmed a torn PCL. Initially my injury was graded at a 1.5-2+, which I was told is right on the edge of what you can live with and rehab without surgical intervention. I was locked out and no-weight-bearing in an immobilizing brace for 3 weeks, but the tibial sag didn't seem to be improving at all. They locked me out for another 3 weeks, and felt like there was sufficient progress to be begin physical therapy. As with everyone else on here, my muscles had atrophied so quickly that I had to rebuild all of the strength in my leg. I made good progress, and within a few months my physical therapists allowed me to do some very tentative jogging to see how things held up.
Unfortunately, they didn't hold up at all. The tibial sag returned and worsened. By my next orthopedic appointment I was graded at a 3+ and told I had no other option but surgery.

I got a call on December 27, 2012 that a donor ligament had come available and I had the surgery on January 15, 2013 during which my surgeon removed my PCL (apparently one end of it had completely torn off the bone, and there was a tear about 3/4 of the way through the middle of the ligament as well) and used the tibial inlay technique to replace it with the allograft in addition to tightening my LCL and MCL, which had both been stretched enough during the accident to not really provide much in the way of stability anymore.

The first few days were brutal. The polar care was the only thing that kept me sane. I was locked out with no weight bearing for 3 weeks. After that I spent 3 weeks still locked out, but able to bear 50% weight on my bad leg using crutches. At the 6 week mark my surgeon told me to lose the brace and crutches and go my own. It was really weird- my nerve endings had been severed and then I hadn't put any weight on my foot at all for weeks- it felt like my foot was all pins and needles for the first few days. I'd say it was a week before I felt comfortable enough to really walk without being overly tentative.

My first few appointments post-op were great and my physical therapists were happy with my recovery. I was able to get through my wedding with no issues, took a 2 week break from physical therapy to head to London and then got back to work. However, at about the 4.5 month mark I started to notice that I could feel a little shifting in my knee at times. It wasn't anywhere as bad as the initial tear instability, but enough to worry me given what happened the first time through my PT sequence. I went in for an emergency check with PT, and they confirmed that I had regained some tibial sag. While they said a little of loosening was to be expected after the transition from lock out to ROM exercises, this was more than they felt comfortable with. No one has ever been able to explain to me why this happened- their only guess would be a fall or a blow to my knee, but I never experienced either of them.

Around this time, I was cleared to jog for 1 minute intervals at PT to try and regain my running form. I never had any pain in the back of my knee, but I started to have a stab of pain in one spot on the front of my knee (right over the top of my fat pad) upon impact while running. After ruling out fat pad issues and instability resulting from muscles that weren't quite back to 100%, my therapists had me run with a tape job that pulled my tibia forward when i flexed my quad- I was able to run with little to no pain. The working theory is that the sag is causing my femur and tibia to contact each other "off" from where they normally would in a solid knee.

So that's where I am right now- 5 months out and fully functional in day to day activities, but only able to run with a tape job or my playmaker PCL brace. It's pretty devastating to make such great progress and work so hard, only to have everything fall apart for no apparent reason twice. I have my next appointment with my surgeon in a month and a half, at which point I can bring up my concerns, but there isn't much he could do short of redoing the surgery. Instead, my therapists have me working on strengthening my quads, hamstring and glutes as much as possible to try and provide the maximum amount of stability to my knee.
I guess my questions would be:

1) Has anyone else had a PCL repair kind of flame out after progressing perfectly for months without experiencing any sort of impact injury or other factor that would stretch the ligament out?

2) Is anyone else competing at a high level in soccer or running moderate distances (I was running 5 miles a day pre-injury) with a sag of probably 1-1.5+?


Thank you,
Melissa

22 comments:

Molly said...

Hi Melissa:

My PCL surgery was unremarkable until scar tissue set in at about 9-11 weeks post-op. As I understand it, your body will overlay an allograft with its own cells over time. During that time, loosening is normal and expected. I wore a functional brace for one year post-op - all the time except when bathing. I continued to wear it for several years post-op when exercising (I rode a bicycle) and would continue to wear it today if I wasn't so darn fat.

My surgeon cautioned me against ANY plyometrics for many months post-op. Other than all that, you recovery seems typical to my experience (minus my arthrofibrosis). Please take it easy - you are recovering for LIFE - there is always time to run and play soccer next year. Seriously.

Mels said...

Hi Molly-

Thank you for taking the time to reply.

I guess this is why I'm so confused- the surgical instructions and PT were the ones who cleared me to jog, elliptical, etc and who had me ditch the brace at 6 weeks post-op. For the first probably 3 months I just pulled in the pool with arms only. I never do anything without getting explicit clearance. But it seems like this is what causes the laxity?

I guess I'm just worried that the activity I was cleared to do has caused this, and there's no solution but having to live with a leg that never feels quite right...

Matthew James said...

G'day Melissa

I'm about 16 weeks out from my PCL reco, im still not running, just using a bike and cross-trainer. My surgeon or physio don't won't me running for another 3 months or so.

But like you i had some hiccups, i have a bit of a sag back and i had swelling and pain something shocking when i first went back to the gym. But my graft is rock solid and i feel i'm starting to make some pretty solid progress.

I'm surpised that your physio has had you working on your hammies, as i was told to avoid this at all costs, because they pull against your graft. I've got another month or so before i can to light hammie work which is killing me because my surgeon used my hamstring as a graft and it's pretty weak.

I'm aiming to be back playing Aussie rules football, in April next year.

Hope that your rehab is back in check

Cheers Jamezy!

Mels said...

Hi Matthew-

I'm so confused as to how my therapy progression and exercise clearance has been so different and much quicker than everyone else. My PTs had me stay away from anything hamstring related until probably the 4 month mark. I never did a terrible lot of hamstring-specific stuff, but there was at least one PT exercise they had me do that was aimed at the hamstring. Did they have you guys doing a lot of weights at the gym? They've had me doing leg press and squats with weight for 2 months or so as well...

I even went back and checked my surgical packet to make sure I hadn't misread, but it most definitely clears jogging and swimming with fins at the 4 month mark.

I'm still jogging (only 20 min cumulative, doing it in 3 min intervals with 1 min of walking in between), and actually not really having much pain. But I am still feeling the clicking in my knee at times when I walk around that I know has to be from the loosening. And wearing the playmaker restricts my movement so much that I can't run at all, so I never use it (with the PT's blessing- they said after 4 months I didn't need it).

I just don't even know what to say anymore... I feel like this thing is ruined and it's not ever going to be solid like they all promised it would be, and that they had me do things way too fast.

Matthew James said...

Every surgeon and physio is different, so there's probably no right or wrong way. And i'm in Australia so it may be even a bit different in different countries. But i'm about 3 1/2 months out from my op, and i still not aloud to run or work my hamstrings and i probably won't be aloud to until Summer.


I've been back doing weights and bike/cross trainer and swimming for about 3 weeks. I did start earlier my my knee swelled up and was pretty painfall so my surgeon got me to ease of for as few weeks.

My still gets cl-icky after a gym session but my physio says my graph feels rock solid and i still have a bit of strech/looseness there. But no where near what is was. My surgeon just said we where gonna take it pretty slow because they do so few PCL's there no totally sure how the graft will go, but so far so good. I made a blog as well
http://jamezy88.blogspot.com.au/


Madalyn Oconnell said...

Hey Melissa! While I've never experienced an injury as severe as this, I can say that recovery and rehab can vary for everyone. I know it sucks to not be able to perform as well as you once did, but the important part is healing fully no matter how long it takes. -Madalyn @ SHC Denver

Anonymous said...

I had PCL surgery September 27th 2013 and right now my surgeon said I should be on crutches another week. My range of motion is at about 90-95 degrees with a lot of pain.

What is everyone else's range of motion at?

Skinnygurl said...

Hi
That's Gotta Hurt and welcome to my blog.
How are you doing? I noted my range of motion throughout my story. If you're interested in comparing go to the beginning of my blog and check it out. My doctor was very conservative in the recovery.
Skinnygurl

Anonymous said...

Your blog has been a lot of help. My whole story is I fell playing softball and I tore my right PCL. I waited to get surgery on it and then I was playing softball on my torn PCL and I fell trying to avoid a tag and because my other knee was weak I fell and tore my PCL in my left leg. Thankfully I didn't tear my ACL or any other ligament.

I had surgery on my right PCL on September 27th 2013. It was a pain walking on crutches with all my weight going on my left leg with a torn PCL but I got through it. I'm walking with a brace now and one day I will probably get surgery on my left leg. My ROM is at about 120 and it is really sore every day but that is expected. I've been drinking a lot of milk for calcium and taking in a lot of whey protein, I think that has helped a ton.

Brandon

Lehua said...

I too have had PCL surgery. My graft has loosen and now I'm worse off than I was pre surgery. Ugh. I can't ride a bike without pain. The only thing I can do is the elliptical with a brace. While standing I cannot flex my knee entirely back. Also, I have patellar tendon pain, which I didn't have before. Before surgery I could walk down hills now I can even walk down steps without pain. Is anyone else experiencing this?

Skinnygurl said...

Lehua,
Sure am sorry to hear that. Can they go back in and try to repair again?
Best wishes to you

Skinnygurl

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Dr. A. M. Rajani said...

PCL injuries can occur with low-energy as well as high-energy trauma. Isolated PCL tears occur in sports, but they are less frequent and less disabling than ACL tears.
PCL tear is often missed or misdiagnosed, and therefore probably more common than believed
symptoms:
Pain at the time of impact which over time may also be felt in the calf region.
Swelling, although this may be minimal.
Instability of the joint, perhaps associated with the feeling of the knee giving way.
Treatment:
In general, most partial or isolated PCL tears can be treated non-operatively because the PCL, with its synovial covering, has some ability to heal.

PCL Reconstruction Surgery
is typically done as an outpatient procedure. Depending on graft choice, open incisions may be necessary to harvest the tissue that is to be used as the new PCL. Knee arthroscopy is then performed to inspect the knee, treat additional injuries (meniscus tears or cartilage damage), and to prepare the knee for the new P

Jai Patel said...

Did you get back to playing??
How is the graft now??
J

Jai Patel said...

Manage to get this sorted?