> The question we would first address is if the PCL is indeed
> completely deficient. The criteria are > 10 mm of
> increased posterior tibial translation (drop-back) on
> clinical examination and stress x-ray. The second question
> is what is the amount of increased anterior tibial
> translation and pivot-shift test result (to determine the
> extent of the ACL tear). Third, is there any damage to
> either meniscus or other ligament structure. In injuries
> such as this (I'm assuming this damage is the result of a
> single injury....or is it from multiple injuries?), it is
> not uncommon for other structures to be damaged.
> Importantly, the posterolateral structures, including the
> lateral collateral ligament, must be examined carefully.
> Did she sustain any bone bruising and if so, to what
> extent? THis would be evident on MRI.
> Has she undergone formal rehabilitation? If so, for how
> long? Has she undergone functional testing to determine her
> knee's ability to withstand turning, twisting, cutting, and
> pivoting? What is the strength of her quadriceps and
> hamstrings in comparison to the opposite leg (this is
> tested using an isokiknetic machine).
> Without the above information, it really isn't possible to
> provide a valid answer to your question. She could be at
> high risk for further damage to her knee if several of the
> above variables exist and if she hasn't properly
> rehabilitated her knee. In our opinion, a complete PCL tear
> does provide, in a highly competitive athlete, an increased
> risk for early joint damage (in a manner similar to a
> complete ACL tear which is not surgically reconstructed).
> We just have seen too many patients who present with a
> history similar to your daughter's in their early 20's with
> knees already arthritic. They undergo PCL reconstruction,
> but the results in terms of functional outcome are inferior
> to those who undergo early PCL recon.
> If you can provide answers to the above questions, I'd be
> happy to correspond further.
> SueBW
Hi SueBW
Thanks for repsonding so quickly. The was no evidence of bone bruising in the MRI. The other findings of the MRI were that the menisci are normal without evidence of tear. The lateral collateral and medial collateral ligaments are normal incourse and caliber without focal signal abnormality. The patellar and quadriceps tendons are normal. The visualized bone marrow signal is normal. The articular cartilage is preserved. There ia a small joint effusion and a small bakers cyst. The patellar retinacula are intact.
She has not undergone any formal rehab or functional testing yet. We are meeting with an orthopedic surgeon tomorrow in order to discuss the most appropriate path forward.
Thanks again for your help. Any additional thoughts would be greatly appreciated.
ScottT
