Has anyone ever elected NOT to have the PLC rec. and stayed athletically active?

[tennis girl]

Hi PLCr's!!!   I am just at a crossroad about this surgery.  I have been diagnosed with PLC,LCL, and possible ACL issues about a year ago.  Had the accident about 2 yrs ago.  After the first 3 months of  rehabbing on my own, my knee seemed strong enough to get back to some running and tennis. When playing, I have minimal pain, instability with quick turns, but really nothing "dramatic."  The BIG problem to me is when I'm not running or playing, when I am weight bearing on my bad leg, it wobbles like crazy. (Looks like I've had too much to drink.)  This is very annoying, but I'm not sure if it warrants a multiple ligament replacement. 

I was wondering if there is anyone out there that has just lived with this "monster?"  Surgeons I've seen have not been able to tell me that, YES, your LCL,PLC, and ACL are torn.  They think I've stretched all or some of these ligaments out due to "seeing" my wobbly knee during weight bearing.  The manual tests that they performed, do not show much difference in laxity, compared to my other leg.  I do want to remain active.  I just need some comments from hopefully, those that have been down this road.   

[queeny]

Out of interest, how did they diagnose the PLC bit? And actually, the LCL and ACL as well if the ligaments dont feel particularly lax compared to the other leg. Why is it not your PCL for instance?

[lenorem9]

Hi Tennis girl,  I had the PLC surgery but just wanted to throw you some food for thought.  Here's a great link to PLC info from one of the US experts.  I think Sue Barber Westin (of Cincinnati Sports Medicine) is on KG's too.  You might try contacting her.

http://www.cincinnatisportsmed.com/csmref/index.asp?ipath=../csm/patedu/knee/lclposterolateral.htm

Here's a couple other good links too.  This might answer some of your questions Queeny:

http://www.sportsinjurybulletin.com/archive/posterolateral-corner-knee-damage
http://www.orthosupersite.com/view.asp?rid=28404

My torn ACL/PLC didn't show much laxity when tested manually either.  It was described to me as "functionally disfunctional".  Meaning I could run, hike, bike and do most everything as long as I was straight and level but if I tried to pivot, my leg would shift and I'd fall down.  Sounds like you are able to do even more than I was.  I can understand why you want to put off the surgery if possible.

From what I've read and been told if your ACL and PLC are torn it's just a matter of time before your knee gives out completely.  There isn't enough blood flow to those areas of your knee to heal them on their own.  I know people that are very active with a torn ACL but I don't know of anyone that has continued with a torn PLC.

I wouldn't wish this surgery on anyone (it's at least a year rehab and very slow recovery) but at the same time if you wait any longer you risk the chance of doing even more damage. 

If I were you I'd get a 2nd or even 3rd opinion to see what other OS suggest.  I'm very interested to see what others suggest and to see how you make out.  I hope you get lots of answers and it's what you want to hear.  Good luck!

Lenore

[Mookie11]

Hi,
Just thought I would chime in with my 2 cents. I recently, in June, had PLC, PCL, LCL etc. reconstruction surgery. It was a 6+ hour operation, one I'd hoped to avoid. I was originally injurred playing ball in early June 07. After having a quickie fix done and sent on my way in August 07, I tried and tried and tried to make the knee work. My days consisted of work and then the knee exercises. I tried my best but the wobbling just got worse and worse until I couldn't take it anymore. Further testing confirmed completely ruptured PCL and LCL along with PLC injuries and I'd managed along the way to damage the ACL as well.  I was advised that it would only continue to deteriorate and put additional strain on the good pieces that were left. My choice was either to have the surgery now or have even a bigger one later after I'd managed to completely destroy my knee.

I don't know the extent of your injuries - have you had an MRI?  There are so many components to the PLC that you will want to find out which of them are damaged. Make sure you get several opinions before you make your decision as you want to be informed as possible before proceeding.

Please keep us posted. The PLC is a tricky business!!

Candace

[tennis girl]

Wow, Lots of good advice.  I've had x-rays, and 2 MRI's, and 6 surgeons look at it.  The first surgeon is from the school of not really telling you what is going on.  He generally told me that it was an LCL sprain, with possible meniscus strain.  Didn't get better, started wobbling after about 6 to 7 months.  Went to another group to find out more info.  They diag. me with a partial ACL tear w/ meniscus tear.  (Both dr.s looked at me and concluded this.)  Went to next group, because I needed another opinion before having the ACL surgery, and was told it was not my ACL, it was my PLC.  (Both dr.s from that practice looked at me that day and concluded the PLC injury.)..... on to dr. # 6, he said that my ACL seemed tight, but seeing the wobbly knee, he would have to say it was my PLC.

Four weeks ago, I was having catching with my other knee, went in to fix the meniscus, but found it to be plica.  While I was under, the surgeon tested the other leg (PLC<LCL<ACL) said that the laxity was "suttle."  ?? He said that in order to fix the wobbly knee, they would look at doing the PLC,LCL, and the ACL.  Wasn't ready for that.  I am just confused!!!!!
Thanks for listening!

[lenorem9]

Hey Tennis girl,  Both Candace and myself (and many others on here) have had misdiagnosis originally.  We can relate to your frustration.  Sounds like you've had your share of surgeons and mixed up confusing diagnoses.  I feel so badly for you.  This knee stuff is all so very frustrating.  Who do you believe? Who do you trust, right?  In my case the MRI was right on the money but the OS's were the ones that were wrong.  What does your MRI show and when was the last MRI done? 

Bottom line, your knee is wobbly and I doubt you'll be able to continue playing tennis on a wobbly knee.  I'm sorry to say that to you but I don't see your knee healing on its own from what you describe.

We're all here to listen any time.  We've all been through it and it isn't any fun alone.

[scoffs]

Hiya

Just to echo what everyone else has already said.  PLC etc is very hard to diagnose and it took me a long time to get to that crucial point.  Like you I could run and play sports (even went snowboarding!) but I just couldn't walk even for a couple of mins without my knee hurting all the time and feeling like it was going to snap backwards.

That's when I decided enough was enough as walking is kinda fundamental.  If you can just stand there without it wobbling all over the place you know it needs fixing really.

It is not a decision to take lightly but ultimately if you can't do the basics you need to resolve it.

Hope that helps 

[CovOne]

Hiya Tennis girl, hope everything is ok, like everybody i am going to add my 2 cents into this topic .

I damaged my knee in March 06, during the first surgery i had allsort repaired which included my LCL, however i was left PCL deficient. Over the next 9 months i went through rehab and got to the stage where i could run with no great pace. However turning was a major problem, i don't no how much was in my head but i definatley didn't want to be turning to quick on it. The surgeon took the decision to perform LCL, PCL & PLC reconstruction to help improve this, i had this surgery in Feb 08 and i cannot tell you how better the knee is now.

Like everybody on here they will vouch post surgery is not a nice experiance however progress is a great thing, currently i am doing really well and just took part in very light football based training the 1st time in 17 months since the injury. The knee was slightly warm after but apart from that no adverse effects.  Muscle power, strength, balance and core stability can still be improved 10 fold so i am looking forward to improving the sitaution over the coming weeks and months. The only downside now is every now and again i get a small locking sensation in my knee, which i am advised is caused by a degenerative tear to the medial minisci which i have had repaired previous but may need a small little op to shave abit more off.

If the options are there i would seriously consider the op, make sure you get a good surgeon who has knowledge of this area. As not all knee surgeons will have encountered our op that often and you should be ok. p.s i am pleased to note my surgeon did perform leg-length tests and xrays prior to reconstruction which have been discussed on another thread.

Good luck all

[tennis girl]

I know that my knee will never be the same with surgery, or even without the surgery.  The wobbling is crazy!
 My muscles have not declined.  I played in a high level tennis tourn. this weekend. (With a big brace.)  Played and moved well.  No instabilities, this weekend.  However, when the brace came off after the matches,  the leg was hyper-extending, and wobbling in a circular motion from the knee down.  It's really pretty funny looking.  Sort of grosses my friends out.

I am still going back to the point that I can still play fairly well, but just don't know if I elect to have the op. if it will give me a better knee than I have now.  Dr.'s tell me that the chronic PLC has about of a 60% chance to improve with the op.  40% is a pretty big failure rate.

If the surgery is performed, I have read all of your PLC rehab stories...... are you able to do anything active besides rehab, in the first 2 months.  I know that the leg will be very sore, but I've NEVER gone more that 2 weeks in my life without doing ANYTHING active.  I don't see how I will even keep my leg locked out for more than an hour.   

The surgeons that I've chosen to do the surgery,( if I actually do it), are in a group.  One has had experience doing this op., the other said that he will be in the operation room observing and assisting.  I have not met with the actual surgeon to talk about his procedure(s), experience, rehab, but if I make up my mind to do this, I will set up an appt. to talk further with him. 

This summer I was going to make a trip to Birmingham, Al. to see Dr. Clancy. (sp?), but  I "chickened" out.  I know he is one of the best, when it comes to PLC's, but a PTherp. friend of mine told me that sometimes the "big" named dr.s sometimes really do not do the "actual" surgery.  He said that they walk around from Operating room/to Operating room, and "impart" their knowledge.  Have you ever heard this?  I think a question everyone should ask their surgeon, if they are in a big group, or well known, is ...Will "YOU" be the actual surgeon performing the surgery?  I know the expertise is there, but I would actually want the dr. I meet with, do the surgery.  Especially if I have to travel to get it done.  Ok, that is my personal opinion.

Thanks for letting me bend your ears.  It is just such a big decision, that I almost wish that the knee would get worse, so that my decision would be easier.  (Sounds bad, I know, but I've just been so undecided on what to do, since the diagnosis.)
Hope everyone is healing well.  Stay positive, and try not to hit any water while you are on crutches.

[lenorem9]

It's a really tough decision Tennis Girl.  I wouldn't want to be in your shoes.  Mine wasn't a tough choice because I knew there was no way I was going back to Taekwondo with a knee that couldn't pivot without falling on the floor.  As it is I probably won't go back anyway but at least now I can do everything else I want and my knee doesn't give out anymore.

You asked:  are you able to do anything active besides rehab, in the first 2 months  Answer:  For me the answer is no.  If you've read all our rehab diaries then you know how long and slow the rehab for this is.  The hardest part of this is watching everyone you know being active when you can't and wondering all the while if you'll ever be active again.  I've been surfing these PLC threads for about a year now and I haven't read about anyone having a failure yet.   I'm not sure I've read a lot about "chronic" PLC problems though. 

Wish I could tell you do it or don't do it but only you know how bad your knee is and what you're willing to put up with.  Sorry if this didn't help any.  Just wanted to let you know we're still listening. 

 

[tennis girl]

Thanks, Lenore!
Thanks for listening.  The dr.s that I've been seeing in this particular group, have not discouraged me from activity, so it makes me think it is ok doing what I'm doing.  They have not mentioned anything about meniscus, cartlidge, or arthritis problems, if I choose not to go through with the op. 
I just wonder if I'm doing damage. 
I hurt some after playing a lot of tennis this weekend,  behind the knee, and medially. But after icing, and a few hours, I have been fine.  I know with instability episodes, one does damage.  But with a loose knee, without pain during activity, I wonder if there is damage being done.  I think the answer would be yes.  But I would think I would feel pain.  As you see, my questions go on and on.  Sorry.  Okay, I am done.   

Lenore, I know if I did pivoting exercises, like martial arts, I would not be able to do it.  I pivot in tennis, but not with a straight leg anymore.  Last month, I was trying to open a heavy door with my hands full of grocery bags, I turned/pivoted on the leg, threw my leg up to open the door, and the knee buckled!!!  Man!! Won't do that again!!!!  In two years, I've learned some of my limitations, the hard way.

Take care.  I wish all you PLCR's a complete recovery. 

[scoffs]

Hi Tennis Girl

Lenore is totally right - you cannot do anything properly active in the first couple of months following the op.  While this is a nightmare for someone who is used to being up and around it really only is a short period of time in the great scheme of things.  I found that just getting around, doing the physio and working was plenty in the first couple of months.  I found lugging around my leg on crutches was a lot of effort to start with and non-weighbearing for 6 weeks was pretty fustrating. However it does end and it really isn't that bad (or has time made me think that  )  I was very active before I injuered my knee, and I was very fustrated during the rehab period, however I have come out of the other side and the result is great.

Sounds like your knee isn't in great shape already.  If you can't do the everyday things but are able to play tennis etc it is a hard choice.  But for me not being able to walk around without having my knee bent a little bit to stop it hyperextending and the worry that all the time my knee was getting progressively worse was enough to make the choice.  I didn't know that only 60% PLCR are sucessfull !!!!  I've certainly not experienced that and I think maybe from the sound of it you perhaps need to see someone more experienced than your current OS.  This is a complex operation and I wouldn't want it done by someone who has only carried it out once before.  Experience is crucial. 

I know it is a big decision but I can say 100% I do not regret having my knee fixed. However you are the only person who can decide what to do.  Basically I looked at it as a few weeks of unpleasantness followed by a couple of months of inconvienence, followed by a couple months of fustration, followed by a couple of months of seeing the light at the end of the tunnel and by then you have seen all the improvements come along and know you made the right choice.  As we can all tell you you'll have a few hiccups along the way but ultimately its not *that* bad.  And so worth it. 

[tennis girl]

Scoff,
Thanks.  I appreciate your comments.  I may consider getting it fixed end of Sept./ beginning of Oct.  We'll see.  I know it will never get easier.  People have told me the younger you are getting it fixed, the better off you'll be.  Well, I am not getting any younger!   It is just that I want to remain active, and know it won't happen for awhile. 
 
:-\What if I could get in a pool and just use my arms?  Is that "doable" maybe on week 2 or 3?

[Mookie11]

Hey There,
Glad to hear you are giving this operation lots of thought. As for my 2 cents... or maybe 3 cents with inflation.... I think you will find that you are very limited in what you will be able to do in the first couple of months post surgery. Not to be discouraging, but you wouldn't want to do anything that would put this complex procedure in jeopardy. It is somewhat of a one shot operation and revision later is more or less a salvage project, as I am told. If you don't do the surgery now, chances are that you will have to do it later as it seems the more the knee wobbles, the more stress it puts on those intact ligaments. I don't know about the pool thing at 2 or 3 weeks post surgery, but I did find my next door neighbour's pool to be awesome once I was allowed to start weight bearing a bit. I could kind of hand on to the side and walk around in there. It felt great and reduced swelling. Whatever you decided to do, we are hear to send you hugs and best wishes from afar!!!

Candace

[scoffs]

Depends if you have a brace etc.  I wasn't allowed in the pool until week 8 and then I did LOADS of swimming but not using my legs (i used one of theose floats that you hold between your knees)  as I wasn't permitted to activate my hamstring properly until week 12.  I had to wear my brace 24/7 for the first 8 weeks (not even showering with it off), then got rid of it after that.

I did however go to the gym and do an upper body workout.  We have a hand bike there and that got me into a right sweat  

[lenorem9]

Hey Tennis Girl, I'm just going through some old posts and wondering how folks are doing.  Did you decide to do the surgery or no?  I haven't seen a post op diary on you so I'm guessing you decided not to do it.

Hope all is well and the knee is holding up OK.

[tennis girl]

I'm getting the knee taken care of on Nov. 14th. Wish me luck.  I'm scared to death!!!!

[Mookie11]

Tennis Girl,
I think you've made the right decision. Though it is scary, just think, you will soon be on the road to recovery instead of sitting on the other side agonizing over what to do!!

All the best,
Candace