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Is it it time for me to change what I'm doing? PCL tear (w/ MRI image)
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I am currently in week 18 post knee injury. I was originally told it was a grade II PCL tear, but then later got an MRI and was diagnosed as a partial thickness tear. I am still unsure and have not been clearly told if that's the same thing?

Anyway, I have seen three different doctors at week 4, week 9, and week 14. Each doctor said surgery is not needed and it will just need a few more weeks of strengthening and limited activity. I have been swimming nearly the whole time and riding since week 10 without issue. Running still causes severe discomfort in the knee and it's similar pain to when I had a large muscle deficiency in my glute.

I've been doing PT for 4 weeks now. No progress has really been made. And if anything, there may be even a little more pain when I've tried to run. Should I consider other options such as surgery or PRP at this point? Or is there something else I should consider?

This MRI was taken at week 8. Roughly 2.5 months ago. Is this even worth looking at anymore since it's most likely much different now?


Last edited by: onceatriathlet3: Oct 13, 18 8:15
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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Partial thickness is the same as grading a tear. Grade II is incomplete and thus typically does not require surgery. It is likely that this is asymptomatic and your pain is due to poor knee kinematics and more PT is required. Back off the running. Improve quad strength in open and closed chain as this muscle is what will support the knee the most and limit posterior translation of the tibia on the femur. Reestablishing dynamic knee control in multiple planes and environments is also required. This is not a short rehab and likely months long. Your pain is likely due to you trying to rush things and increase your activity too quickly. These do heal with time and appropriate forces... not overdoing it. Don’t go looking for surgery if you’ve already been told no. PRP is not indicated. Time and PT will be your best solution.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [AndrewL] [ In reply to ]
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Thanks for the response! I want to clarify some things I said and ask for clarity. I am not currently running and haven't been for four a little over four weeks. I have been doing massive amount of quad exercising and strengthening, and the last four weeks, they've focused on my hamstring and glute because they felt there might be a slight imbalance. The only time I do is a 10 minute warm up on the treadmill during my PT sessions. Do you think that riding, and even swimming could be overdoing it? I do not feel any pain when riding, but I could easily see how that motion would irritate it.

I am currently at over four months, where nearly everything I've read says that it should be a 12 week (or so) injury and I would be back to normal training by now.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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I had a PCL tear last year in a bike crash. The ortho did not recommend surgery, which I was glad, and advised to strengthen my legs. My primary training and background is strength training so he said that I would probably do better doing my own PT than using their PT group. From that point I started slowly with the understanding it was going to take a long time. I started back cycling very soon after, but with very flat courses and low resistance spin sessions. Enough to get motion in my legs and yet not enough to stimulate training so I was losing cycling fitness over the months ahead.

It took over 6 months of slowly progressing and yet I was probably more progressive than most PT's.
In some cases it just takes time and patience. Over a year later and I am still working on some aspects of this rehab. Still working on regaining strength on full squats.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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Cycling could be the culprit. Anytime you come out of the saddle from a seated position it will stress the PCL. Having said that, everyone is different in terms of healing time. PT is definitely where you need to be so a skilled clinician can stress the PCL and stimulate the correct deposition of collagen fibers in the PCL. Check the populations in what you've been reading because they could be less active and allowing more healing.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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I’ve probably had more experience than most with a PCL tear.

I partially tore mine when I was 15 playing hockey. I was able to play 3 years in college with out issues I was off and on the year after I tore it. Sometimes it felt good sometimes it didn’t. I didn’t play most of my senior year in high school because of it. I’ve done Tris competively since college, not as much the last few years but the first few after college I was training a ton.

Sometime during the other hockey seasons it went from a partial to a full tear which I trained on for a very long time. Because of how strong your quad probably is, you shouldn’t have too much pain or issues. The only time I would have issues training , was with running because the the impact would jam my lower leg back. Sometimes it was fine sometime it hurt a bunch.

This final straw for me was skiing. Because the quad supports, the PCL tear normally won’t cause issues. However when you’re maxing your quad there is no more support to keep your lower leg in place. This causes it to move a ton and can really be painful. I got to the point where I couldn’t ski for more than 3-4 minutes before I had to stop.

Luckily, within the last 5-7 years they have got the technology to the point where they can do a PCL reconstruction without any issues. It’s pretty specialized. Even my surgeon had only done about 4-5 before mine because it’s so rare to have happen. Personally if it’s not bothering you after PT is done, I wouldn’t even worry about it. By the time it fully tears the procedure should be even easier and you’ll be fine with surgery.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [Grant.Reuter] [ In reply to ]
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It has actually been bothering more since I started PT about a month ago. Now it sometimes feels weak or I feel slight discomfort even when just walking or standing versus 2-3 months ago when it would only hurt when I tried to run. Ironically enough I was doing self PT before I started with a doctor a month ago. I was doing mainly quad strengthening and it was feeling good. The PT has had me switch focus to hamstring and glute and it actually has been feeling less stable since the switch. I'm not sure if that's worth mentioning or not. This is one of the reasons I'm thinking of quitting PT and going back to my own program.

Interesting on the surgery. May I ask what your recovery time on the surgery is?
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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That’s strange. I get working all leg muscles but hamstrings I would expect more hamstring with and ACL tear. I’d get a second opinion with a different PT on what they would do. Isolated PCL tears are very rare. It would be entirely possible for no one at that PT location to have ever seen one.

Surgery recovery was pretty easy it was 4 years ago so I don’t remember all the details but I think I was biking inside within a week or so and then outside in 6-8. I think running was maybe 3-4 months. Back to normal then at 6 months. It wasn’t a horrible surgery by any stretch.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [onceatriathlet3] [ In reply to ]
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It’s possible that what you’re reading to say 3 months after PCL is to return to typical daily activities, not high level exercise. My guess is that you have at least 3 more months.

It’s possible that running or swimming is causing your pain, but it should hurt while you do it or immediately thereafter. You need to evaluate what you are doing, how often, how stressful it is and what other things are contributing to your problem.
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Re: Is it it time for me to change what I'm doing? PCL tear (w/ MRI image) [AndrewL] [ In reply to ]
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I'm a teacher, which involves a good amount of standing but I usually measure myself with at least 8,000 steps per school day to make sure I'm fully engaged with students. I have no idea if that's a lot or not. Truth be told a lot of time I usually stand in front of the class, I found a stool and podium to cut my standing about in half.

I thought about getting a brace, but my PT said it probably wasn't necessary and would only prolong because I would be giving too much support and weakening it by providing a crutch for it.
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