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PCL Prognosis?
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I just got home from my MRI follow up with my orthopedic specialist, and I was diagnosed with a Grade 1 to 2 PCL injury. No surgery, 6 weeks PT. So I'm not looking for a diagnosis, but hopefully perspective and suggestions.

The story: I managed to pick up a puncture in my front wheel in the last 100 yards or so of an olympic tri 2 weeks ago and crashed - HARD - during my flying dismount onto a bent knee. Resulted in my first DNF.

In the past week, I've been able to build back up to 100% power on the bike and 10 min running intervals. Feeling pretty good in both sports. Had skipped swimming to let the road rash heal without infection risk and figured the 20 years in the pool in my shoulders would carry over for a few weeks well enough.

My ortho is concerned about the PCL injury being exacerbated by running or swimming (the 'snap' in a kick) and wants to let the 'looseness' of the PCL to tighten back up. My brain is telling me I'd normally step back and take whatever time away from swim/run as needed. My heart dilemma is that I'm also two weeks out from my first half ironman. The knee has improved exponentially day-by-day since the injury and to be honest, I expected the appointment today to confirm that I was ok to race (even if that meant 'participate' instead of race). But today's instruction was to not race at all and it came as a total surprise. He did promise to review the MRI with a colleague mid-next week in an effort to see if her opinion differs.

As I typed this it made me feel like a hypocrite for not wanting to throw in the towel on this race (really, on the 6 month build to it) when my doctor is telling me to not risk long term damage, but I wanted to see if anyone had a similar experience or suggestions. Is it worth seeking a second (third?) opinion? Am I not fully grasping the long term risks?

Thanks in advance. I'm frustrated with myself and a little embarrassed to be asking for nearly-but-not-intentionally medical advice but this doesn't seem like a common injury and I'm not finding much information at all online, let alone tri-related.

KJ
Swim and Triathlon Coach
AllTerrainEndurance.com
KJ@allterrainendurance.com
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Re: PCL Prognosis? [swim13] [ In reply to ]
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My PCL was damaged 30 years ago while playing rugby. A big Samoan forward put an awesome below-the-knee tackle on me while I was in accelerating (in those days I was a track sprinter).

It still have remnants of a PCL in my knee, but it’s so loose it is non-functional. I can’t sprint without the knee swelling up; sprinting drills are impossible. Kicking in the pool is a pain and skiing requires a brace and plenty of anti-inflammatories. I am apparently guaranteed arthritis at some point.

Take the advice. If your injury could recover fully, I would provide as much time as possible to let that happen.

BH
PS In my day they could not reconstruct a PCL (cf ACL). They probably can now - but that would likely require 6 months off training, plus the expense/pain/hassle. Rest sounds better, no?
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Re: PCL Prognosis? [BigHammer] [ In reply to ]
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Wow. Thanks for the perspective, that definitely helps. I'm struggling because the injury is nowhere near where yours was, but 30 years from now I don't want to look back at this month and know that not just eating my preparation and registration fee resulted in painful swimming (my happy place) and arthritis.

PCL reconstruction is a thing now (according to my research) and I certainly don't want surgery. Fortunately the injury isn't at a surgical scale at this point but my doctor did say that if I were to worsen it severely then I'd be a candidate.

Thanks again. Trying to get over my pity party - should probably take this to the 'cry like a little biatch' thread instead.

KJ
Swim and Triathlon Coach
AllTerrainEndurance.com
KJ@allterrainendurance.com
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Re: PCL Prognosis? [swim13] [ In reply to ]
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swim13 wrote:
Wow. Thanks for the perspective, that definitely helps. I'm struggling because the injury is nowhere near where yours was, but 30 years from now I don't want to look back at this month and know that not just eating my preparation and registration fee resulted in painful swimming (my happy place) and arthritis.

PCL reconstruction is a thing now (according to my research) and I certainly don't want surgery. Fortunately the injury isn't at a surgical scale at this point but my doctor did say that if I were to worsen it severely then I'd be a candidate.

Thanks again. Trying to get over my pity party - should probably take this to the 'cry like a little biatch' thread instead.

Great to see that you are looking at being more cautious.

I tore mine June 2017 in a crash (noted here) and 19 weeks later I was still doing my own form of PT (noted here).

There were two things that helped me take my time and be patient in terms of healing and strengthening the area. First, I am sadly a veteran of healing from various injuries over the years and have learned to be patient and cautious and second was a coworker that fell and tore his PCL bad enough to require surgery at the same time I tore mine.

I was on the way to progressing in healing and Tony had to wait weeks for his surgeon to have an opening to perform the surgery. He was on crutches until that time. After surgery he was on crutches for many weeks, then a cane for many weeks and then limping. All of this spanned almost a full year where I was well past all mine and doing well. Tony still walks with a slight limp 2 years later. As I healed and got to see him at work it reminded me that one potential misstep and that could be me.

2 years later and only slight moments I can feel it slip, but I have plenty of strength around my legs and it is amazing how that strength can compensate quickly. When my ortho suggested no surgery and that I should do what I can to regain and keep strength that was in my wheelhouse because I specialize in strength training. In fact he suggested that I skip their PT and do my own based on my experience. Most of all I am grateful to have taken my time and slowly and cautiously comeback.

Best wishes on the recovery even if it feels well now just be cautious and look at long-term health.
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Re: PCL Prognosis? [Felt_Rider] [ In reply to ]
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Thanks for sharing those two blog posts - sorry about your crash. Based on your pictures, looks like your point of impact on your knee was about the same as mine. I'm sure your colleague's injury was a great dose of reality too.

Unlike you, I have little experience in returning (properly) from injury. My freshman year of college I dislocated my shoulder which resulted in surgery, but swam through the remaining 2 months of the season prior to having the procedure. I was out of the sling and 'swimming' two weeks sooner than expected, but I was 10 years younger! Also hard to accept I'm getting older :)

I have no interest in another surgery. That sucked. Thanks again for sharing your story!!

As an aside, I'm finding a very interesting and stark contrast between feedback here and with (generally older) people in person vs. social media. On Instagram, everyone says "Oh ya you can do it, you can always walk the run if you need or DNF!" But your stories here and a guys I was talking to in my bike shop yesterday are a whole lot more reasonable, as in 'take the time, recover, come back later.' I'm definitely going to listen to people with direct experience over well-meaning folks on the IG.

KJ
Swim and Triathlon Coach
AllTerrainEndurance.com
KJ@allterrainendurance.com
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Re: PCL Prognosis? [swim13] [ In reply to ]
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Ok - got some more information from my orthopedic.

He recommended I consider a PRP (platelet rich plasma) injection. Initial impressions from my internet searching and conversations are that its success are anecdotal, but for those who believe it worked it really worked. He basically framed it as "I know you're eager to get back into your training, and this may provide a route for you to do that" but there's no guarantee. I'm leaning toward doing the procedure, but some of the feedback I've received is that it was really painful for up to a month after the injection - since I'm not in pain now (a major reason why I'm so frustrated with this injury), I don't know that it's 'worth it' to possibly impact even regular day-to-day life and the $1k out of pocket for a gamble.

Found some good stories and feedback in some other threads but curious if anyone has thoughts on the 'dilemma' it feels like I'm in. I've been fortunate enough to not have had an injury requiring time off in 10 years so I am feeling extremely out of my element. Thanks!!

Other PRP threads:
PRP for shin pain
PRP/Stem for Labral Tears
In parallel with stem cell
PRP for meniscus

KJ
Swim and Triathlon Coach
AllTerrainEndurance.com
KJ@allterrainendurance.com
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Re: PCL Prognosis? [swim13] [ In reply to ]
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An update:

I'm now 6 weeks post injury, and feel fine 99% of the time. The knee will be a little tight most mornings but it feels more like a knuckle that needs to crack than anything else. If that's my only long term issue, I'll take it.

First - I did not race AZ70.3. Still a little bummed and a little lost planning the 2020 season. Open to race suggestions!

I opted NOT to do PRP. I spoke to several other athletes (one pro) who underwent PRP for various issues as well as PTs who work with folks who've received the treatment. They all spoke very highly of it, but those who received the treatment were experiencing significant pain. Since I was not, I decided I did not want to make myself hurt on a gamble.

My PT introduced running via the Alter G treadmill at 4 weeks post injury. The knee felt mostly ok, a little stiff during the swing. I have to say, if you've never experienced the Alter G (or similar), running at 50% body weight was incredible! We've been introducing 10% body weight during each subsequent session, so I may be looking at running without weight assistance in a week.

As far as other clearances, I'm allowed back out on the roads cycling (no MTB yet) and have to wait another 2 weeks (8 weeks post injury) before I reintroduce kicking while swimming, so I'm slowly becoming friends with the pull buoy.

Thanks again for the feedback I received here and elsewhere. It was truly appreciated.

KJ
Swim and Triathlon Coach
AllTerrainEndurance.com
KJ@allterrainendurance.com
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