Tarkman1 - Grade III MCL and complete PCL tear

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03-06-2006, 03:22 PM
tarkman1

Tarkman1 - Grade III MCL and complete PCL tear

My ACL held up. The MCL and PCL didn't. Also, I do have bruising to both tissue and bone. I'm not sure whether the edema mentioned in the MRI report refers to the swelling that I have (that is coming down). I'm looking for a second opinion regarding treatment (this doctor is a US Ski Team physician). My current doctor has me in an immobilizer even though I can take my knee through about 90 degrees for range of motion and also bear weight without pain. From what I've gathered about knee immobilization it seems to be that I'm past the point where I need that. Still, I'm dealing with a compound injury so I don't quite understand how things work in concert.

I'll see what I learn from the other doctor.

See Page 2 for the MRI Synopsis
03-06-2006, 03:35 PM
hemlock hiker

+++++ VIBES +++++ sent your way Tarkman.

What kind of surgery (if any) or treatment are you looking at?

I'm having a brain fart right now, but I had a CPM (something passive movement) after my last ACL reconstruction and it helped alot in recuperation time. As well as the stationary bike. Stay strong!!
03-06-2006, 03:38 PM
Bodhi

Quote:

Originally Posted by tarkman1

My ACL held up...

Good news...

Quote:

The MCL and PCL didn't...

Fack, huge bummer, heal up mang.:frown:

Quote:

I'll see what I learn from the other doctor.

Good idea.

Take care and get better.

++++++vibes++++++

peace,
D.
03-06-2006, 03:42 PM
GT40

So what treatment is the Doc reccomending?

Hope you can get back out skiing soon.
03-06-2006, 03:45 PM
Ridgehippy

Not what any of us wanted to hear but at least it wasn't the worst the Doc could have told you. It'll be a long season, get on the PT and heal up quick. +++++++ sent.

Shout if you need anything....I'm just down the road.
03-06-2006, 03:50 PM
DJSapp

That's terrible man. Heal up fast and straight and get back to Gordy's camp.
03-06-2006, 03:51 PM
Mulletizer

That sounds very ouch. Sorry to hear about it and hope it heals fast. ++++++
03-06-2006, 03:51 PM
Tyrone Shoelaces

Sorry to hear this man. But like others have said, at least your ACL is intact.

I'd be interested in hearing what the docs prescribe for your recovery too. I've done my MCL in the past as well, and that injury was 6 weeks of rest with lots of bike riding. I'm curious to see how they treat this with the PCL injury along with it.

Regardless, take it from someone who just came back from ACL reconstruction...hit the PT/rehab with more ferocity than you think you have in you, stay more positive than you've ever been before, and keep your eye on the light at the end of the tunnel....because there is one. Who knows...you're next season coming back from injury could just be one of the best ones you've ever had....:)
03-06-2006, 03:52 PM
tarkman1

Surgery is a question mark.

I read the MRI report that mentioned possible compression fractures to the tibia plateau. I had the x-rays with me when I saw his colleague previously. I don't know that the doctor from today knew that I had an x-ray come out negative for the tibia and tibia plateau.

I'll let the next doctor know for sure what I can and what I cannot do with my knee. I'll have the x-rays. As far as I'm concerned, an MRI write up is only one piece of the puzzle.
03-06-2006, 04:09 PM
cold_smoke

PCL is bad news as you already know. It is a rare tear with very few specialists that have even performed the reconstruction (would have been 'better' to tear the ACL/MCL). My friend did his ACL/PCL a few years back and re-tore them. He was going to have an osteotomy to remove part of the tibial plateu to minimize the stress on the future PCL, as reconstruction has something like an 80% failure rate. He opted out of the painful and long rehab of the osteotomy and is now two weeks out of ACL/LCL/PCL/Posterior Corner/Parial removal of the medial meniscus surgery. The doctor did a double cadaver wrapped PCL graft.
In short, be really careful with the PCL and if surgery is needed, seek out a specialist and don't over exert the knee in any way.
Good Luck with everything, keep us posted, +++vibes for a strong recovery.
03-06-2006, 04:11 PM
Mulletizer

Quote:

Originally Posted by tarkman1

I read the MRI report that mentioned possible compression fractures to the tibia plateau. I had the x-rays with me when I saw his colleague previously. I don't know that the doctor from today knew that I had an x-ray come out negative for the tibia and tibia plateau.

I think this came up when Samwich hurt himself a while ago; the distinction between compression fracture and bone bruising is slight and depends mostly on the doctor. In fact, I think they amount to more or less the same thing. Perhaps a medic will be able to help.

Here's hoping you will not need surgery.
03-06-2006, 04:16 PM
hop

+++++++++++++++++++++++++++++++++
03-06-2006, 04:17 PM
mtnbikerskierchick

Sorry to hear about your injury. Yeah, I would surely check with another doc about the immobilizer. It's my understanding that unless you have a lot of bone or meniscus damage, you shouldn't be in an immobilizer..... You should be in a brace that will keep you from hyperextending, but not in an immobilizer. Immobilizers can cause more scar tissue to build up, which can inhibit rehab. Also, immobilizers cause your muscles to atrophy even more and it's better to prevent that b/c it also lengthens rehab. I remember I lost 10 lbs of muscle during my knee surgery (ACL reconstruction), and they tried preventing atrophy by having me ride the stationary bike and swim before surgery. Anyway, good luck to you! You will heal soon I'm sure!!!!! :)
03-06-2006, 04:36 PM
tarkman1

Thanks all.

I don't like the immobilizer. I've found that I can stand on my bad leg without pain and without difficulty. IYeah, I'm not too stable but I can do it. Really, given what I can do now what I really need. I'm not the 'classic case' nor do I have classic symptoms right now.

My whole problem with the immobilizer is that it seems to be a step backwards where I'm not convinced that such restriction is necessary. With the restriction, I'm limited to leg raises and flexing my quads. I'm certain my legs bring a lot of stability to my knee. Immobilization just seems wrong if it's not necessary for the MCL to heal. I'd like to start rehab as soon as I can.
03-06-2006, 04:39 PM
ptavv

Sorry to hear about that man. You'll make it through the rehab, you just have to perservere. Remember, the most epic winter is always the next one.
03-06-2006, 04:55 PM
caddah

good luck with the injury. multiligament tears are tough. I've been trying to get through a complete knee dislocation since september. Talk to your doctor and get in to rehab. I ended up being immobilized for 2 months and lost all my muscles in my left leg. keep as strong as you can and do the excersizes religously.

I'm not a doctor, but the immobilizer seems wierd. scar tissue build up is one of the most painful and difficult things to get rid of.

keep us posted....interested in seeing what the doc says.
03-06-2006, 05:09 PM
Jim S

Quote:

Originally Posted by tarkman1

My ACL held up. The MCL and PCL didn't. Also, I do have bruising to both tissue and bone. I'm not sure whether the edema mentioned in the MRI report refers to the swelling that I have (that is coming down). I'm looking for a second opinion regarding treatment (this doctor is a US Ski Team physician). My current doctor has me in an immobilizer even though I can take my knee through about 90 degrees for range of motion and also bear weight without pain. From what I've gathered about knee immobilization it seems to be that I'm past the point where I need that. Still, I'm dealing with a compound injury so I don't quite understand how things work in concert.

I'll see what I learn from the other doctor.

Can you get the report and post it? Edema could be in the marrow (bone bruise) or in the ligaments. Rarely cartilage edema. We usually don't mention edema of the menisci.

Tibial plateau fractures are easily missed and often not well seen on xrays. They are much more readily seen on MRIs. It's common to have a normal xray and then see fractures on the MRI (common: I see it nearly every day at work).

Most )not all) PCL and MCL injuries are treated conservatively (non surgical therapy).

MCL strains and bone bruising can really hurt. Been there done that. Feel better.
03-06-2006, 05:14 PM
Raps

hey tark sorry to hear that man, definately get a few different looks at it from a couple docs - hope you are back out there soon and at Gordys camp again next year....
03-06-2006, 05:15 PM
WhiteHunter

Sorry to hear this news. Also tough to hear that the course of action is still uncertain. The waiting has to be more unnerving than anything else at this point. Hope you get some better news soon.
03-06-2006, 05:29 PM
Mr. Altagirl

Sucks to hear this. I had a grade III MCL and a fractured Tib-Plateau last year (plus some other crap thrown in to make it that much more enjoyable) and did not use an immobilizer. I did have to go 6 weeks of complete non-load bearing due to the fracture; that was the hard part; hopefully you can stay away from that. Even though I couldn't do any load bearing exercises or movement, my PT was VERY aggressive and I skied about 6 weeks after the injury (and continued for about 100 days last year). Make sure your PT uses the E-Stim machine and try to abuse it; I really think I was able to ski last year because of the lack of atrophy I had due to the aggressive PT and especially the vast amounts of E-Stim I did. Plus, it is really fun to make the other patients in PT freak out as you make your leg go ballistic working out with the E-Stim. Good luck!
03-06-2006, 05:37 PM
Barnballs

that blows dude.

On the bright side...looks like we'll be skiing till the 4th again though.
03-06-2006, 05:59 PM
Jim S

Isn't that from the topsheet of the 06-07 K2 Maden AK?

http://www.untracked.com/pics/product_images/176519.jpg
03-06-2006, 07:39 PM
skier0178

Heal up quick Matt. You're a strong guy, it's not going to be easy but you'll get through it. Put up a big picture of TOTW focused on Balls wherever you do rehab, that will get your juices following. Let me know if you need anything to help the process....
03-06-2006, 07:55 PM
Vinman

For the most part the PCL probably is not as much of a concern as the MCL. Although the PCL is a major ligament in the knee it is a much less devastating injury when compared to an ACL tear.

The possibility of compression fractures does complicate things some. But as you already know they may or may not do surgery on a grade 3 MCL. If they feel it is completely torn then they may go ahead and fix it. If it is not complete the may hold off and see how well it heals on its own.
03-06-2006, 08:16 PM
team ftb

Looks like someone will be purchasing a lot of porn now:biggrin: .

Pro-active recovery is the only way to go as I'm sure you're well aware. Be focused and be dedicated in the recovery. Thoughts are with you.
03-06-2006, 08:51 PM
Arty50

Here's hoping it's good news the rest of the way out. I can't wait to schralp Mammoth with you when you get back on skis.
03-06-2006, 08:54 PM
tarkman1

transcription of the MRI (the knee isn't nearly as swollen as it was when I had the MRI on Thursday)

Radiologists, orthos, or anyone knowledgable in general please let me know your thoughts. If being able to walk, retract the foot/bend the knee, support weight without pain bears any significance, let me know. If it means nothing, please let me know.

Feel free to call: Matt 760-458-5092

PROCEDURE: MRI LEFT KNEE WITHOUT CONTRAST

INDICATIONS: Left knee pain and swelling following skiing accident

IMPRESSIONS:
1. There is a complete tear to the posterior cruciate ligament but the anterior cruciate ligament is intact.
2. Grade III tear to the medial collateral ligament which may extend into the medial patellar retinaculum.
3. Suspect a compression type fracture to the lateral tibial plateau anteriorly with extensive microtrabecular injury and marrow edema.
4. There is also some minimal marrow edema in the medial tibial plateau posteriorly suggesting additional microtrabecular injury.
5. There may be meniscal capsular separation present associated with the body of the medial meniscus with some possible traumatic intrasubstance tearing to the body of the medial meniscus.
6. Linear increased signal in the anterior horn of the lateral meniscus but the signal does not appear to extend to the free articular surface.

TECHNIQUE: The patient is studied on the Siemens Symphony 1.5 Tesla short bore magnet. Scan sequences include sagittal proton desnsity and T2 weighted turbo spin echo scans, coronal proton density and fat suppressed T2 weighted scans, and axial MEDIC scans. Meniscograms are also produced.

COMPARISON: No prior studies are available for comparison.

DISCUSSION: Coronal T1 weighted images demonstrate a complete tear to the medial collateral ligament with a considerable amount of edema surrounding the medial aspect of the knee. There may be a meniscal capsular separation to the body of the meniscus on the medial side as well. Minimal linear increased signal in the body of the medial meniscus is also noted possibly representing some intrasubstance tearing of the body of the medial meniscus. The anterior and posterior horns of the medial meniscus appear to be grossly intact.

The lateral meniscus also demonstrates some linear increased signal in the anterior horn of uncertain clinical significance. The body and posterior horn of the lateral meniscus shows no abnormalities. The anterior cruciate ligament is intact. Extensive edema is seen surrounding the knee both medially and laterally but more on the medial side.

On the coronal T2 fat saturation images there is extensive marrow edema in the lateral tibial plateau with loss of the cortex anteriorly and I suspect a compression frature to the lateral tibial plateau anteriorly. There is also some marrow edema in the medial tibial plateau far posteriorly suggesting additional bone contusion. A moderate joint effusion is also present. No patellar abnormalities are detected. The medial retinaculum also appears to be some discontinuous and I can not rule out an injury to the medial retinaculum as well.
03-06-2006, 08:55 PM
altagirl

Damn. Sorry to hear that but hopefully you'll get a further diagnosis and get moving on the road to recovery soon.
03-06-2006, 09:13 PM
addict

I've already posted this in the gimp section, but can you straighten your leg Tarkman? I'm either 2 or 3 weeks (can't remember how much couch time it's been) post MCL injury and I still can't straighten it. I'd love to hear from anyone that's been in this position....
03-06-2006, 09:41 PM
fez

when i tore my right acl i drove myself to the hospital. the hospital gave me a knee immobilizer.
I hobbled out to the car, looked at the car, looked at the knee immobilizer. realized there was no way i would be able to drive with the immobilizer. i pulled the immobilzer off and haven't worn it since.
$98 for 50 yds of walking in the immobilzer, sweet.
03-07-2006, 01:00 AM
Squirrel99

Tark,
positive thoughts for a quick recovery. looking forward to skiing w/ya again next time I make it down to mammyland.
03-07-2006, 01:50 AM
Jim S

You got my PM on that MRI.
03-07-2006, 08:43 AM
tarkman1

Jim S

I didn't see a PM in response to the MRI report that I posted. Feel free send me a PM or post it on this thread.
03-07-2006, 08:58 AM
Jim S

Dude,

Douche your in box. It's full and won't accept any PMs.

Jim
03-07-2006, 08:59 AM
Jim S

I'll post here:

You need an above the knee amputation and should sell your gear on TGR.

Seriously, clear your in box and I'll PM you. I don't think this is for the masses...just my opinion.
03-07-2006, 10:52 AM
tarkman1

Boxed cleared.
03-07-2006, 11:00 AM
K-Stormchaser

Heal up man...I'm in the same boat, surgery scheduled in 3 weeks for ACL.
03-07-2006, 12:14 PM
Gebster

Real bummer to hear about the extent of the damage. Heal up fast and hope to see you hanging out up in Mammoth with the crew during the recovery.
03-07-2006, 09:23 PM
tarkman1

Update:

I went to another doctor today. I'll be rid of the immobilizer on Thursday when I get another brace (my third). The new brace will allow me to flex my knee but restrict motion that would interfere with MCL regeneration. I'll be doing physical therapy to include range of motion exercises, stretches (calf and hamstring), and general leg muscle exercise. I was told to begin walking (assisted by crutches) and bearing weight.

The difference in treatment between the two doctors was very different. In the end, I am going with the second doctor, who treats US Ski Team members, for the more active recovery. Despite the rather unique nature of my injury, the doctor has seen this type of injury. I'm not in uncharted waters. I have a follow up in three weeks. I'm on the sideline now and in a helluva lot better spirits now than I was yesterday.

Don't count me out for the season yet.
03-08-2006, 01:58 AM
Gebster

That sure does sounds like better news.