Q. I am a 20-year-old college soccer player who last week landed directly on my knee and felt a pop.
I went to the team physician who thought my knee was “loose” and believed that I had an ACL tear. When I got the results of my MRI, I was told I had a PCL tear and that the ACL was fine. The doctor said that I needed surgery but that I still may not be able to return to soccer.
I am confused as to the change in diagnosis, the need for surgery, and the possibility I may not be able to play again. Any advice would be appreciated.
A. There are four main ligaments in the knee that maintain stability. The MCL and LCL are important for stable side to side motion. These ligaments have a good micro circulation and can usually heal without surgery.
The ACL and PCL cross deep inside the knee and are important for pivoting activities. These two ligaments have poor micro circulation and, if injured, usually require surgery to reconstruct the damaged ligament.
Of injuries to the cruciate ligaments (ACL and PCL), the ACL is the ligament torn 97% of the time. This explains why your physician at first thought your ACL was torn. However, unlike ACL injuries that likely require surgery to return to soccer, many PCL injuries can be treated non surgically.
Surgery depends upon the associated damage to your knee and the degree of instability. Many grade 1-2 injuries can be managed with bracing and rehab followed by a return to play.
Recently, a PCL dynamic brace (PCL Rebound brace) has been released that helps significantly in PCL healing and rehab. In grade 3 injuries with severe instability, surgery would almost definitely be needed to return to play.
If you are not yet comfortable with your doctor’s opinion, you may want a second opinion from an orthopedic surgeon that deals with elite athletes.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net