Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :

PCL injuries - PT vs Operating - - Posted by Gym_Mom (Gym_Mom), 9 April 2004

My daughter sustained a gymnastics injury recently was diagnosed with a grade III posterier drawer and a grade III posterolateral drawer, which I have deciphered to mean 2 torn ligaments, the PCL and the PLC. She got hurt almost 3 weeks ago and has never been in a tremendous amount of pain (with the exception of the 1st few days). She is walking without a brace or crutches and has just started physical therapy. Her ortho wants us to consider surgery, and i get the impression he thinks it should be done whether or not she wants to continue in the sport. She has some instability in her knee, but nothing that has caused her any problems in her daily routine.

I have done some reading and have learned that the post op rehab is difficult and the surgery is tricky. I have also spoken with gymnasts that have competed with a completely torn PCL (with a brace).  I am not sure if they had other ligament damage, but again, from what I have read, it is difficult to completely tear a PCL and NOT incur some other ligament damage.

I guess I would love to hear about people that have similar injuries and have not opted for surgery. Have you been able to return to competitive sports? She is being fitted for a Donjoy Fortitude brace this week. Have you found a brace to be helpful? Is it unusual to have two grade III tears and not have any symptoms?

This is a great board - I look forward to your feedback - especially anyone from the gymnastics world!
Posted by ATsoccergirl (ATsoccergirl), 13 April 2004

I would highly suggest getting a second opinion.  Very few OS can properly diagnosis a posterolateral complex injury.  Which is evident when he used a PLC drawer, which is a very imprecise test.  

In terms of surgery, if the PLC is indeed damaged, it is imperative that it is fixed.  Trying conservative treatment for this could result in even more damage such as ACL tear, mensical or articular cartilage damage.  I would also consider doing the PCL at the same time.  This way you only have one inflammatory response, and only one surgery.  This will greatly enhance the outcome of the graft stability also.  If you only fix one, the graft will be subject to a much higer amount of stress than in a normal knee, or if both were done at once.  It will also greatly reduce the chance for complications since the joint will be traumatized once.  

It is a very tough surgery, with a long recovery time (18+ months).  I had an ACL and PLC reconstruction.  I am very happy I did it, I noticed an immediate difference in stability and I had a great outcome.  Some of the downsides include the longer period of crutch usage, longer, less agressive rehab.  She will also be more prone to developing a cylcops lesion since the ROM cannot be pushed.  

I would highly suggest pre-op physical therapy, I was in physical therapy for almost 4 months prior to surgery and this really helped me.  I had no ROM problems, and I was able to return to soccer in the absolute minimal time.  it also made it easier to regain strength, since I had very little atrophy.  

If you have any questions, please feel free to either send me a private message or e-mail me.  

Best of luck to you and your daughter!

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.