The Other Cruciate

Monday, December 10, 2007

With thousands of pounds of humanity surrounding the hole, the running back finds a crease. The hole disappears and the mountain collapses. Like penalties, injuries likely occur on every NFL play, but they’re usually of no consequence. Unfortunately, Reggie Bush can’t waive his knee. An MRI and a second opinion likely means Mr. Bush’s season has come to an end because of a posterior cruciate ligament tear.

The PCL is the poor stepsister to the ACL, the glamour ligament that gets all the attention. No ACL means no stability in the knee, an operation and months of rehab. The PCL is too tough to easily reach with the arthroscope or graft and the repairs tend to stretch and fail. While orthopedic surgeons want to operate (they are surgeons, after all) the PCL is often left alone to heal with physical therapy and lots of work in the gym.

If Mr. Bush’s knee had read the textbook, a cruciate ligament tear would feel like a pop in the knee followed by pain and instability. There is significant swelling in the knee joint within a few minutes and because of the fluid buildup, it is difficult to straighten the knee to full extension. The knee joint has only so much space and as hydraulics has taught us, you can’t compress fluid, so the knee is held in about 15 degrees of flexion, where the joint has its most space.

The pain and swelling make it tough to examine the knee immediately to determine if the cruciate is torn and in a pro football player, the exam is even tougher, since the bulk and strength of the quad muscle can trick the examiner into thinking that the ligaments are intact when they really aren’t.

So it’s off to the MRI and the diagnosis is made. For Mr. Bush it’s good news that his ACL is intact, it’s a reprieve from the operating room and instead it’s weeks of rehab. But rehabbing what?

The knee doesn’t care what causes the bleeding and fluid, it just knows that there is some badness within it. The quads shut down and start to weaken almost immediately. This is tough on knee stability since the quads will have to be the structure that keeps the knee stable and protects it from sliding back, the former job of the PCL. The initial therapy of ice, compression and rest will give way to progressive workouts when the swelling goes down and the fluid goes away.

Elite athletes fool us mere mortals into thinking that anybody can recover from knee injuries, arthroscopies and other assorted damage in minimal time. The time and intensity of their training is matched only by their mental strength in overcoming the pain that they put their body through to reach their goals in record time. If we can learn from them, it is the resilience of the body. But we forget the 10 and 12 hour days they spend each day “at work” fixing their injury.

And when you think of how quickly an athlete gets back on the field, please consider other “athletes” Think of the strength of an open heart surgery patient who gets to go home only four days after having his chest cracked open.

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The Other Cruciate

With thousands of pounds of humanity surrounding the hole, the running back finds a crease. The hole disappears and the mountain collapses. Like penalties, injuries likely occur on every NFL play, but they’re usually of no consequence. Unfortunately, Reggie Bush can’t waive his knee. An MRI and a second opinion likely means Mr. Bush’s season has come to an end because of a posterior cruciate ligament tear.

The PCL is the poor stepsister to the ACL, the glamour ligament that gets all the attention. No ACL means no stability in the knee, an operation and months of rehab. The PCL is too tough to easily reach with the arthroscope or graft and the repairs tend to stretch and fail. While orthopedic surgeons want to operate (they are surgeons, after all) the PCL is often left alone to heal with physical therapy and lots of work in the gym.

If Mr. Bush’s knee had read the textbook, a cruciate ligament tear would feel like a pop in the knee followed by pain and instability. There is significant swelling in the knee joint within a few minutes and because of the fluid buildup, it is difficult to straighten the knee to full extension. The knee joint has only so much space and as hydraulics has taught us, you can’t compress fluid, so the knee is held in about 15 degrees of flexion, where the joint has its most space.

The pain and swelling make it tough to examine the knee immediately to determine if the cruciate is torn and in a pro football player, the exam is even tougher, since the bulk and strength of the quad muscle can trick the examiner into thinking that the ligaments are intact when they really aren’t.

So it’s off to the MRI and the diagnosis is made. For Mr. Bush it’s good news that his ACL is intact, it’s a reprieve from the operating room and instead it’s weeks of rehab. But rehabbing what?

The knee doesn’t care what causes the bleeding and fluid, it just knows that there is some badness within it. The quads shut down and start to weaken almost immediately. This is tough on knee stability since the quads will have to be the structure that keeps the knee stable and protects it from sliding back, the former job of the PCL. The initial therapy of ice, compression and rest will give way to progressive workouts when the swelling goes down and the fluid goes away.

Elite athletes fool us mere mortals into thinking that anybody can recover from knee injuries, arthroscopies and other assorted damage in minimal time. The time and intensity of their training is matched only by their mental strength in overcoming the pain that they put their body through to reach their goals in record time. If we can learn from them, it is the resilience of the body. But we forget the 10 and 12 hour days they spend each day “at work” fixing their injury.

And when you think of how quickly an athlete gets back on the field, please consider other “athletes” Think of the strength of an open heart surgery patient who gets to go home only four days after having his chest cracked open.

Leave a Reply

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