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Author Topic: Torn ACL / PCL / LCL and limited ROM  (Read 691 times)

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Offline ogtel05

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Torn ACL / PCL / LCL and limited ROM
« on: December 16, 2010, 08:28:04 PM »
I'll try to be brief:

Pedestrian, Male age 40, hit by motor vehicle, late July 2010.  Life threatening injuries but survived; L knee sustained torn ACL, PCL and LCL and was dislocated.  R leg had multiple fractures that are now healing.  Other: fractured pelvis, 4 broken ribs, ruptured bladder and both lungs (pneumothoraxes) - all healed.  I'll focus on the L knee here as it is proving troublesome.

I wore two external fixators to keep the leg straight (blown LCL allowed tibia to kick out laterally) and due to lack of motion the knee has stiffened considerably.  When the second x-fix was removed my ROM was 15 to 50.  I've since had 2 weeks of PT and worked on the L knee at home; ROM is now 7 to 65.  I believe there is a fair bit of scar tissue built up, and the knee has stabilized: my doc has approved weight bearing on the L leg.  I am still NWB on the R leg while waiting for a tibial fracture to heal (bone graft), and have been wheelchair-bound for nearly 5 months.  I was extremely active (basketball, weights, etc.) at a high level prior.  You can imagine I am nearing the end of my sanity and thus am seeking help here.

My questions:

1. We have not replaced the ligaments as abrasions at the necessary incision sites took forever to heal, and it's unlikely I'll really be on my feet until another 6 - 8 weeks have passed.  Has anyone experienced 6 - 7 months NWB, and how long did it take you to walk again?  The muscle atrophy is shocking and has me concerned, but I suspect the muscles can be rebuilt for the most part.

2. My doctor has suggested that if my L knee remains stable and I regain sufficient ROM to perform daily activities, we may choose not proceed with the ACL and PCL grafting as the surgery may compromise my ROM.  This means I won't play basketball or other "torquey, twisting" sports again but I'd actually be happy if I could walk, handle stairs, and bike again (comfortably, without pain).  I also have 3 small children who I'd like to play with.  However, high level sports I can live without in exchange for walking, stairs and kid-play.  Any opinions on this potential path?

3. While my ROM is improving with PT, I am concerned that the gains will slow or stop as I suspect profuse scar tissue is present.  I have not been Dx'd with arthrofibrosis but will be mindful of symptoms and ask for additional MRIs, etc. if warranted.  Can most patients get to full extension and about 110 degrees flexion over time and with proper PT over an 8 week period?  I assume AF cases are exceptional and will see poorer results.

4. Any suggestions on top doctors I should see in the Boston area?  I am currently with the folks at New England Baptist and they seem quite good; however a second opinion / consult can only help.

Naturally, any thoughts related to the above (or not) and return questions are welcome, and thanks in advance for all replies.

Best -

Ogtel05

Offline soozles

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Re: Torn ACL / PCL / LCL and limited ROM
« Reply #1 on: December 16, 2010, 10:53:43 PM »
I don't have much experience with your injuries, but boy oh boy, it sounds painful. I'm glad the life threatening issues are behind you and you're on your way to recovery. I can't say what life without both a PCL and ACL will be like, but in your case, the scar tissue might be a good thing as that's what's keeping the knee together, which may be why the doc thinks you can be ok without it. That's just my guess though.

No idea of docs in the Boston area, but I would look at the bigger hospitals there, see who's at Mass General which I believe is the "big" hospital in Boston. Generally, doctors at the good places have to be good or they wouldn't have gotten privileges there.Sorry I don't have much help for you, I just wanted to wish you the best of luck in getting better soon.
May 2005: Torn PCL, misdiagnosed as chondromalacia
April 2010: pain worse, lots of instability
Nov. 23, 2010: PCL reconstruction
progress here: http://pclrecovery.blogspot.com/

Offline ogtel05

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Re: Torn ACL / PCL / LCL and limited ROM
« Reply #2 on: December 19, 2010, 08:55:21 PM »
I don't have much experience with your injuries, but boy oh boy, it sounds painful. I'm glad the life threatening issues are behind you and you're on your way to recovery. I can't say what life without both a PCL and ACL will be like, but in your case, the scar tissue might be a good thing as that's what's keeping the knee together, which may be why the doc thinks you can be ok without it. That's just my guess though.

No idea of docs in the Boston area, but I would look at the bigger hospitals there, see who's at Mass General which I believe is the "big" hospital in Boston. Generally, doctors at the good places have to be good or they wouldn't have gotten privileges there.Sorry I don't have much help for you, I just wanted to wish you the best of luck in getting better soon.

Soozles: thanks for the well wishes.  I'm seeking a second opinion (Jan 12) from Dr. Tom Gill who I believe is head of sports med at MGH and is the team doc for the Patriots and Red Sox.

ROM did not really improve during this week of PT although I continue to work on exercises at home twice daily.  Extension is at 6 and flexion at 69.  Can anyone comment on what is needed for walking and stairs (I believe Dr. Noyes' article on this site specified 2 and 70 for walking / stairs and wonder if anyone here has a similar ROM to what I currently have)?

Thanks again for any / all replies.















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