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Author Topic: first time injury - acl and posterior lateral corner  (Read 20840 times)

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Offline kshoe

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first time injury - acl and posterior lateral corner
« on: January 10, 2009, 01:16:38 AM »
I'm a first timer to the board and am so glad it's here!  I'm finding lots of good info, but wondering about my own injury and if anyone else can give me an idea on what they've found with acl complete tear, meniscus tear, combined with grade 2 posterior lateral corner injury.  My surgeon says I need to wait 8 weeks post injury before having the acl/meniscus repair surgery.  He says my grade 2 plcl should heal without surgery, but I'm worried about that.  So many posts talk about their plc surgery and very few talk about healing without surgery.  I'm doing PT until then, but I feel like it is so far away.  I've got a full leg brace with ability to fully bend it and can walk on it too.  Pain is sporadic except during some challenging PT, when it is worse.  No painkillers have been needed and I'd love to know what's down the road for me.  Any info is greatly appreciated!   
12/28/08 ski injury - acl, meniscus, plc

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #1 on: January 10, 2009, 05:24:16 AM »
Hi there,

Am surprised you have to wait 8 weeks. Normally they like to do ACL reco's soon after an injury to get the best results. I would definitely be getting another opinion.

How was you PLC injury diagnosed ? I have a problem with mine at the moment and is not getting better after a month. Got to manage it conservatively for another 3 weeks. It sucks !!! I've read that most PLC injuries require surgery.

Good if you haven't needed painkillers. My PLC injury has been really painful and feels very unstable right now.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Kaputt_Knee

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Re: first time injury - acl and posterior lateral corner
« Reply #2 on: January 10, 2009, 10:12:29 AM »
Current ACL repair thinking is that as long as there are no contra-indications the best results are achieved with reconstructions carried out after the trauma swelling has gone. This can be anything between 4 to 8 weeks so don't worry about the delay. The brace will help reduce the chance of further damage to other ligaments or cartilaginous surfaces (articular cartilage and menisci). It also gives your knee stability in normal day to day activities.

You can help the recovery post-op by working on achieving full ROM (range of movement - from fully extended to completely bent knee). If possible it also helps to build up as much muscle strength as possible, especially in the quadriceps and hamstrings. If you are having physiotherapy then talk to the therapist to find out what they recommend. Again going into an ACL recon with good muscle definition and strength is also important in helping a complete and rapid recovery and return to sport.

I tried the conservative route when they discovered that I had a PLC injury last summer. However, it turned out that my injury was from my original injury 2 years ago and that it had healed incorrectly, trapping the nerves in the scar tissue. We tried for 8 weeks to release this with intensive manual manipulation and mobilisation, but it was basically too late. So in August last year I had surgery to revise an incorrectly placed ACL reconstruction and repair the PLC injury by resetting it. They also found that I had a ruptured lateral collateral ligament which also dated from my original injury (probably but difficult to say exactly). This was also reconstructed but I'm not sure where they harvested the graft tissue from. I was non-weight bearing for 4 weeks then put in a brace restricting my flex to 90° for 2 months or so (can't remember exactly). I returned to work after 6 weeks and am now preparing to return to sport (5.25 months). My knee feels better now than at any time since my original injury in March 2006.

It's to your advantage that your orthopaedic specialist recognised the PLC injury, it is missed by many, even very experienced surgeons. At least he/she will be monitoring it. In a lot of cases it is overseen completely and leads to post-op complications.

If you read some of the sticky (fixed) threads in the Cruciates section you will find lots of information with regard to pre and post op exercises. In the Information Hub there is a huge amount of information about the anatomy of your knee, the operative procedures and post operative rehabilitation.

Remember that many people come to this board when they have problems post operatively. Literally hundreds of thousands of people undergo treatment for these injuries without ever having to use the internet to provide information. As a result the boards are definitely skewed to giving the impression that the outcomes are uncertain or even unsuccessful. The successful people come, use the information they find and move on as soon as they achieve full functionality. That's why there are nearly 24,000 registered members, but the number of active members at any one time is probably only numbered in a few hundred. As for the 100 or so regulars, such as myself, I have made a lot of really good friends via this board and enjoy helping others, if I can, to avoid the some of the pitfalls I found in my recovery.

The other MAJOR bonus with the board is that when you come here to moan or whatever, everyone understands your pain and frustration as they have all been there at some stage or another.

I'm assuming that you are in the USA, based purely on the time that you posted. There are lots of people here who know a great deal about good surgeons and also specialist PTs in the States, so welcome and don't give up yet!  ;)


Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #3 on: January 10, 2009, 11:25:13 AM »
Hi Sue,

I am interested to hear what kind of conservative treatment they did for you PLC injury. My knee surgeon and sports physician want me to try conservative treatment for another 3 weeks at least. I am doing a strengthening program and the week after next can do a session in the gym and a couple of sessions in the hydro pool.

What sort of symptoms and problems did you experience with your PLC ? Just curious to know. Mine is very unstable at the moment and keeps hyperextending backwards. The pain has been pretty bad too, but has settled down a bit.

Love to hear your thoughts.

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Kaputt_Knee

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Re: first time injury - acl and posterior lateral corner
« Reply #4 on: January 10, 2009, 12:21:02 PM »
Kirsty,

I had lateral instability from day 1 but that was put down to weak muscles following my ACL recon. I built up the muscles and was doing OK for about 14 months, then I started to get pain in my knee at really weird times which I could not associate with any movement. I ignored it for a long time putting it down to "getting fit again". The pain was at first just flashes radiating outwards then up and down the leg - so I knew it was nerve pain and said OK the nerves are starting to fire.

Then last March it started to be stronger and the frequency increased along with episodes of my knee giving way when it was under particular load. It locked up a couple of times, so I thought I had another meniscus tear. I worked through it for a while then went to the best specialist I could find. He diagnosed it along with my incorrectly placed ACL graft.

Treatment at first was deep manual massage to release the scar tissue and break it up as the MRI showed that the PLC had fractured very close to the knee capsule and healed incorrectly positioned. The capsule release type massage was excruciating but it did free up the movement a wee bit. However the instability episodes increased as did the blinding shooting pains - I would be mid-word teaching when the nerves fired and could not speak for several seconds (seemed like hours to me!). After the knee gave way a couple of times, once as I was descending the stairs at work and only just managed to catch myself on the bannister, he decided he would take a look when he went in to revise my ACL. He ended up reconstructing the PLC but the exact details of how etc, no idea. I just know it worked.


Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline kshoe

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Re: first time injury - acl and posterior lateral corner
« Reply #5 on: January 10, 2009, 01:37:19 PM »
Thanks for the info Sue.  Yes, I'm in the states - NH to be exact. 

Your advice about the members who partipate in discussions is exactly what I was thinking.  It is going to be a long haul for me, but looks like not as bad as for many of you guys with worse situations than me.  I'm really working hard at therapy 2 times a week and everyday at home 3x/day.  I feel pretty good, but have so many questions about what is "normal."  Surgeon and PT tell me I'm in great shape already (am very active in a lot of sports), but to make sure I keep as much of that as possible before surgery.  Did you feel like that is possible with 8-9 weeks between injury and surgery?  It us almost a mental thing for me since I worked to hard to get in shape and now I can't even break a sweat!  I'm doing the exercise bike once a day for 15-20 minutes at a medium/slow pace.  It feels good to do it, but my knee is certainly tight at the top of the circle.  My knee actually feels the worst in the am, but after some of the exercises it always feels looser, but still sore.   I don't want to overdo it, but will ask the PT if I can go longer on the bike.

My surgeon and physical therapist seem great and have come highly recommended, so I feel comfortable with them.  I did have two other OS look at my knee and results too.  I'm trying to look thru all the different boards and posts over the next few days, but want to thank all of you for putting your info out there for scared people like me!

Thank you!
Kathy
12/28/08 ski injury - acl, meniscus, plc

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #6 on: January 10, 2009, 02:21:44 PM »
Hi Sue & Kathy,

Glad to hear you have a supportive PT, Kathy. Sounds like you have been working extremely hard at getting your knee right. I am sure it will make your recovery that much easier even though you may be looking at a long recovery. I see a different physio for my knee and shoulder. My shoulder physio is fantastic, but not happy with my knee physio. Think I may look into getting a new knee physio. At the moment I do not need to do any formal physio on my knee, which is good. My sports physician is just guiding me on my rehab and what he wants me to do until I see my knee surgeon in 3 weeks time.

Sue, thanks so much for sharing your experiences. Like you, I have had lateral instability from the start and a lot of sharp pains as you described. The pain you described you experienced up and down your leg is interesting. That is what is happening to me at times. I am going to right down everything that happens in the next few weeks. So, that when I see my OS he will have a good idea what is going on. At the moment I am wearing a hinged knee brace and on 2 crutches. Did you have to wear a brace and use crutches when you first injured it ?

Good luck with your recoveries.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kshoe

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Re: first time injury - acl and posterior lateral corner
« Reply #7 on: January 12, 2009, 11:41:57 PM »
Hi kj -
It sounds like you are waiting to see your surgeon and not doing any physio?  They had me in physio 2 days after my skiing injury and I'm going to them 2x week and have lots of exercises at home everyday.  I started with two crutches and a big brace and at 15 days post injury I am using no crutches and only the bendable brace.  They want me to protect the plc injury by using the brace all the time except at physio.  But I feel better than I did in the beginning, so the exercises are doing something good.  The outside of my knee (radiating down) and the back of my knee are the most painful areas still - probably due to the plc injury.  I'm hoping the surgeon diagonsed my plc correctly since his recommendation for my grade 2 injury is to let it heal for 8 weeks before going in to do the acl/meniscus repair.  If they get in for the recon and find more problems with the plc I'll go crazy since it will mean more surgery later.   I hope they find your injury is not too bad, so good luck at your appointment.

Kathy
12/28/08 ski injury - acl, meniscus, plc

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #8 on: January 13, 2009, 11:14:31 AM »
Hi Kathy,

I am doing my own physio at home. Just doing static quads and light knee lunges which my sports physician gave me. Next week I start back in the hydro pool and exercise bike in the gym. Can't wait to exercise again. It has almost been killing me !!! I go back to my sports physician on the 27th of January and see my OS on the 2nd of February. Still can't walk on my knee about 5 weeks post injury. It keeps hyperextending on me backwards. Did you have that feeling ? I've had knee problems for over 15 years now so know what exercises are most important. So, generally don't need to bother with seeing a physio formally.

Make sure you ask the surgeon to fix your PLC if they find more damage than expected. The last thing you want is to go in for further surgery. LOL. My OS does all he needs to instead of the patient having to go under twice. :)

Good luck with your physio.


11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #9 on: January 16, 2009, 10:55:16 AM »
Hi Kathy,

How are you doing ?

My knee feels like crap. Was in a lot of pain when I came home from work tonight. So, took two of my strong painkillers. Will do more of my exercises before I go to bed tonight.

Just 2 weeks and 3 days till I see my OS. Can't wait for some more answers and to see if he can do anything. Still not able to do a leg raise, even with my brace. Quads are stronger but not much else. Start back in the gym and hydro pool this week. My body is dying for it.

Have a good weekend. :)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kshoe

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Re: first time injury - acl and posterior lateral corner
« Reply #10 on: January 16, 2009, 01:22:01 PM »
Hi kj -

I'm hanging in there.  But I think I'm learning about overdoing it.  It doesn't take much for the pain and swelling to get worse if I don't stay off it!  I feel like I should be getting rid of most of the swelling, but it is not happening.  I'll see the OS next wednesday and hopefully he can give me a date for the surgery in March.  Time is dragging by.  Therapy is getting harder as they can see what I'm able to do, but it makes me nervous to try harder things since I don't want to injure the plc worse.  That seems to be my worst part.  I don't even think about not having an ACL until my knee buckles.  I have constant low pain on the inside of the kneecap which I'm guessing is the meniscus tear area.  I'm being so good wearing the brace all the time, so I hope the plc area doesn't need anything but time to heal.  If they had to add that to the other surgical repairs I'll be in bad shape. 

I actually do feel better when I've done the exercises and stationary bike, so hopefully you'll feel better after getting in the pool and gym.  I think I can stand all the physical aspects of a knee injury, but it's the mental issue for me....I just want to stay in shape, but know it is not going to happen  :(

Hope you have a better day today! 
Kathy
12/28/08 ski injury - acl, meniscus, plc

Offline Kaputt_Knee

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Re: first time injury - acl and posterior lateral corner
« Reply #11 on: January 16, 2009, 01:53:15 PM »
Hi Kathy

you can help reduce the swelling by using RICE - Rest Ice Compression and Elevation (might be teaching my Granny to suck eggs here but what the he!!  ;) ) So all the time you are not using the leg, elevate it as best you can - above the heart is best but often difficult if you are working  ;D. And while elevated, ice like there is no tomorrow and do ankle pumps like an Olympian. I use a mixture of icing and heat (cherry stone cushion warmed and placed on the knee).

If you can run to it finding a good therapist who knows what Lymph Drainage massage is about is also good for rapidly reducing swelling. It is often used in the USA and UK for beauty treatments, but it's original purpose was to encourage the re-absorption of lymph fluids released during a trauma. Here in mainland Europe it is widely used post operatively as well as after accident trauma. But you do need someone who really understands how it is done properly, not just as an adjunct to some stupid beauty treatment to make lazy ladies think they have lost weight by expressing excess fluid from the bodies. It is a very gentle massage to stimulate the lymphatic system in the knee and leg to remove the excess fluids causing the swelling. I found it very relaxing and effective - but I always need the bathroom after the treatment, so something  must be working somewhere!  ;D ;D ;D ;D

You can stay in shape during your injury, it's just a mental battle that many of us lose. Keeping up the muscle bulk and strength is a good way to prepare for surgery. Being inventive about getting round your pain rather than swallowing pain-killers and trying to work through it is one way to tackle the problem. I think the mental battle is harder than the physical one.

I had an ACL revision, lateral collateral ligament reconstruction and PLC repair all in one go and here I am 5.5 months later planning my return to the ski pistes in a month or so. I am getting nerve pain again, quite severe at times, but I look at it as being a sign that the nerves are not dead and they are finding ways to fire. Or maybe my increasing fitness programme is aggravating the nerves on the outside of my knee - who knows. My shin and the inside of my calf are still completely numb and that annoys me rather than bothers me. Sometimes feels like my shin bone is cushioned with jelly between the bone and the skin, but it is not stopping me from working through my exercise programme. I am gradually increasing weights and repetitions under guidance from my therapists, both of whom are skiers and very supportive.

It sounds to me that you have a good surgeon Kathy who has a plan for you. With the work you are doing it should be 100% success when he operates. Mess ups are way rarer than you would think if you just read the various Knee Injury Bulletin Boards. Even here, reading the Cruciates Board you will find lots of success stories.

Keep positive and believe in yourself, your bodies ability to heal and your surgeon's skill and you will be skiing again next winter!


Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #12 on: January 18, 2009, 04:04:22 AM »
Hi Sue & Kathy,

How are your weekends going ? We've got some lovely weather here today in Melbourne. It is supposed to make 26 degrees today.

Sorry to hear that you are struggling, Kathy. Not long to you see your OS now. I hope that they can book you in for surgery soon so you can get on the road to recovery. There's nothing worse than waiting. My PLC feels crap still. Knee still hyperextends backwards, which is very annoying. Getting a lot of pain on the posterior lateral side. 2 weeks and 1 day till I see my OS. Will be glad to know what I am dealing with.

I totally agree with you, Sue. It is a much tougher mental battle than a physical one although the pain can be bad at times.

Kathy, I have a saying that I constantly refer to when I am struggling, "never give up on what you want to achieve". It was used in a bank advertisement on tv a couple of years ago and have never forgotten it. You will get there with perseverance and hard work.

Enjoy the rest of your weekends. :)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kshoe

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Re: first time injury - acl and posterior lateral corner
« Reply #13 on: January 18, 2009, 02:21:42 PM »
Thanks for your supportive messages kl and Sue.  I think I'll make it thru this ordeal just fine because I'm working hard and reading such awesome messages from others who are going thru it too.  Amazing how much better I feel knowing i'm not alone!

I had a rough day on friday and felt weak and frustrated with my overall physical well-being.  My knee was not cooperating with me at all and I was wondering what more I needed to do.  Then I read Sue's message about RICE and I realized I'm going to need to do a better job of that.  Voila!  After two days of major RICE except for my exercises I feel so much better.  Less swelling and more confidence that I have the power to improve my own situation. 

I'm spending about 20-25 minutes on the exercise bike in the morning.  Then doing my exercises 3x/day AND lying flat on my back with my leg iced and raised above my heart for about 30 minutes after each round of exercising.  Of course I feel like a complete slug lying around so much, but it does the trick for the knee.  I hope to get permission to do the eliptical after my OS visit on wednesday, so wish me luck.  I am planning on being in the best shape possible by surgery time (praying it is no later than early March).  My next PT visit is on tuesday and I hope they measure my ROM to be really close to full extension and a few degrees of on the flexion.  I know my OS wants me to be in the brace all the time, but I wonder if that will continue up until surgery.  I dread thinking about this brace on now and for so long after surgery.

The mental game is a tough one, but I love the slogan you mentioned kl....."never give up on what you want to achieve."  I think I'll put it on my screen saver to remind me constantly. 

kl - hang in there until you see your OS.  What do you think they'll tell you?  Do you think your plc will need surgery?  Hopefully the visits to the gym can give you some relief in the meantime, but it sounds like you're having a tough time with the pain.  It is no fun when your body is not working right!  After realizing you are in Australia I hope you can get out and enjoy the nice summer weather.  Unfortunately for me. here in the US, we have a winter storm today and another 9 inches of snow coming down.  Great for the skiers....bad for me to get out of the house at all :(

Take care -
Kathy
12/28/08 ski injury - acl, meniscus, plc

Offline Silkncardcrafts

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Re: first time injury - acl and posterior lateral corner
« Reply #14 on: January 18, 2009, 06:03:46 PM »
Hi Kathy,

The mental side of it is definitely the worst part. I try to stay positive and keep thinking of the good things I can do, but is definitely hard sometimes. One of my old physios was really positive and said to focus on the things that I can do, but at the moment that is so hard as I am just so limited in what I can do.

Glad the icing is helping. I think I need to start icing more again. My knee has been feeling very painful lately. I can't sleep because of the pain tonight. Very annoying as I really need the sleep. I think I will need to work from home today as you are not supposed to drive with the meds I have taken.

Sorry to hear you had a rough day on Friday. My body is not cooperating with me full stop at the moment. As I am back on crutches it is badly affecting my back and right shoulder too. I injured them in a car accident last year and just made them worse.

It sounds like you are able to do a lot of exercise at the moment, which is great. That is something I want to work on. This week I can start going to the hydro pool and gym again. My body has been screaming out to do some exercise, so looking forward to being able to do something. Hopefully you will get the go ahead to do some work on the eliptical. It is a great machine and great for those that have knee problems. Is a great body work out.

Not sure what my OS is going to say. He may want to continue with conservative treatment, but I will tell him that I've had enough and also explain how much of an impact it is having on my life. When I tell him that he may decide to do something. I sure hope so. My knee surgeon will probably be reluctant to do something, but knows when I am struggling and had enough. He knows no matter what I work at my rehab very hard.

Yesterday I got out and went to a big shopping centre. I bought some Christmas wrapping paper that was on special. One of my hobbies is card making. So, will come in very handy for this year's Christmas. Going to be more organised this year. I also went to Myer, a large department store we have in Australia. Was hoping to use my gift voucher which I got for my birthday, but didn't find anything I really needed. Think I will go into the big one in the city this week some time. Just I could have been able to go for a week yesterday as it was such good weather. Oh well, guess I'll get there. Just very frustrating at the moment.

Going to try and go back to sleep now. :)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty