PCL & ACL Tear

Fall of Number 7

Story

On October 11th, 2019 in the first ever game between a NFL team, The Denver Broncos, and a CFL team, The Saskatchewan Roughriders, it resulted with the Roughriders enduring a great loss. One of their team members suffered a painful injury nearing the end of the of the game. Number 7, Aaliyah Dressler was tackled and suffered a direct blow to her knee, which was already bent in a 145° angle. While going for a one handed reception, Dressler was suddenly tackled by the Broncos player, number 18, Lance Manning causing her shin to push back immediately turning the 145° into a reflex angle of 210°. Fans in the crowd have claimed to have heard a loud popping sound during the time Manning tackled Dressler. Immediately after the tackle, Dressler fell to the ground and screamed in pain as she clutched her knee. Trainers rushed onto the scene but the damage was done. The amount of players allowed on the field during any given play is still unknown.

At the Time of the Injury

McMurray Test

Lachman Test

Pivot Shift Test

Reverse Pivot Shift test

Injury Test

Dial Test

Drawer Test

After the injury, Dressler was immediately transferred out of the field, the game medic performed RICE on the injury to prevent any further damage to the knee. RICE stands for rest, ice, compress and elevate. Dressler being a professional star athlete was transferred to the medical stadium where she waited for the doctor to arrive. Her teammates on the bench sent their condolences for her injury.

Dressler was finally met by Dr. Ponsaran, joint injury specialist as well as the on game medic who had to prepare the room and supplies for him to perform several tests on her knee to indicated which specific part of her knee was injured during the tackle. Dr. Ponsaran performed tests such as the McMurray test which indicates if the meniscus of knee is injured by moving the knee abductly and adductly, the Lachman test which indicates if the ACL is damaged by bending the knee at a 20°-30° angle pushing the tibia up, if the the tibia moves forward more than usual the ACL may be damaged. The pivot shift test, also for the ACL, performed the whole leg is turned medially at the extension position and bending it at a 20°- 30° angle and a clunk should be felt when the flexion of the knee is happening. The reverse pivot shift test, this test indicates if the PCL is damaged, performed by starting the knee a 90° angle and straightening it, while it is being straightened there should be a clunk heard during the process. The posterior drawer test is for a PCL tear, it is performed by having the knee at a 90° angle and pushing the tibia downwards from its position and if the knee pushes back more than it should be, it could be a PCL tear. The dial test, is for PCL tear, the test is performed when the patient is at a prone position and flexing both knees at a 90° angle and if the knee move more than 90° it indicates the certain type of injury. The Valgus stress test for the the MCL, the test is performed by lifting the leg up and bending it at a 30° angle and moving the tibia abductly and if it moves more than it should the MCL is torn. And lastly the Varus stress test for the LCL, the test is performed when the leg is lifted up and bent at a 30° angle and moving the tibia adductly and if it moves more than it should the LCL is torn.

The symptoms for both a ACL and PCL year were shown during the test but risks cannot be taken, for safety and full proof that it is a PCL tear and not meniscofemoral ligaments, Dressler had to take an MRI scan.

Varus test

Valgus Test

Diagnosis and Anatomy

Dr. Ponsaran had special access to the MRI Lab, so Dressler was able to take an MRI scan the next morning. An MRI scan stands for magnetic resonance imaging, which uses magnets and radio waves to look at organs, ligaments and tumors in the body. Dressler could have also taken an ultrasound but the MRI scan was easier to look at rather than a ultrasound.

The knee is made up, held up and stabilized by many ligaments and cartilage. Parts on the knee include the two ligaments as either side on the knee in the medial and lateral sides which holds the femur and tibia together and prevents the tibia from moving side to side, these ligaments are re the MCL and LCL. The next part of the knee rests on top on the tibia, these are cartilages called meniscus, these cartilages give comfort to the two bones allowing smooth movement between the two. The next part of the knee is located between the femur and the tibia, this ligament is called the ACL. The ACL joins the two bones together and prevents the tibia from sliding forward. The next part would be the PCL located the back of the femur and the tibia. The PCL joins these two bones as well and prevents the tibia from sliding back. The next part would be the patella ligament which joins the patella to the femur at the top and the tibia at the bottom.The ligaments that Dressler torn during the game was the PCL and ACL, which creates terrible instability to her knees. Manning gave her a Grade 4 PCL tear, which means that Manning not only injured her PCL but also another ligament which just happened to be her ACL.

Surgery and Rehabilitation

Surgery and Rehab

Dr. Ponsaran recommended that Dressler should go with the surgical option for the injury due to the fact that two ligaments in her knees were torn and a non-surgical option would not the gave the best results for recovery and strength to the knee after her surgery and rehab. The non-surgical option would also risk more injuries on the knee in the later future. Dr. Ponsaran said that the wait for a surgery procedure would be a few weeks or months depending on the schedule of the OR rooms as well that two surgeries will be needed for the injury.

The surgery that would be performed would be the new procedure called the BEAR procedure which stands for, Bridge Enhanced ACL Repair. The BEAR procedure was new and had less recovery time than the ACL reconstruction surgery. The BEAR procedure requires the torn ACL to be held up by sutures while a sponge is place between the two sides of the ligament. After the sponge is placed blood is taken from the patient and is injected into the sponge. After the blood is injected the two pieces of the ligament is pulled into the sponge. Once the surgery is completed the sponge will do its job in the next few weeks as the ligaments heal and repair in the sponge.

The PCL surgery would be held before the BEAR procedure. The surgery consists of drilling a through the tibia and placing at the top of the knee graft through the hole and replacing the PCL and while it is pulled and secured by an Achilles bone with a button and sutured attached at the back. The suture is then secured at the front by another button. The graft is the passed through a hole at the bottom of the femur, securing it and allowing the feeling process to happen.

In the following weeks after the surgeries Dressler must undergo rehab for 6 or more months, that start with just basic knee movement with a knee brace. Improvement exercise is necessary for the knee during the recovery months and many movement exercise are given and assigned for the recovery of the torn ligaments. After recovery, physical exercise is still needed to keep the ligaments strong for years to come.

Sources

PCL Ligament Rupture:

https://www.goudelis.gr/en/content/posterior-cruciate-ligament-rupture

PCL Ligament Injury:

https://www.webmd.com/fitness_exercise/posterior-cruciate-ligament-injury#1

PCL Ligament Injury 2:

https://www.health.harvard.edu/a_to_z/posterior-cruciate-ligament-pcl-injuries-a-to-z

Test For Examination of the Knee:

https://www.youtube.com/watch?v=c3643PM0a2o

ACL Tear:

https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738

ACL Surgery:

https://www.healthlinkbc.ca/health-topics/hw28289

PCL + ACL: Grade 4 Recovery:

https://www.joionline.net/trending/content/what-recovery-time-pcl-tear