Major Knee Injury : Help with my Sporting Future

[Dafydd]

Hey Guys,

This is a pretty comlplex one, and from what I uderstand of the nature of my injury, one for the experts! Around one year ago, (March 2007) I suffered a dislocated right knee playing rugby. This resulted in;

- Medial Collateral Tear
- Poster Cruciate Ligament Tear
- Anterior Cruciate Ligament Tear
- Fractured and "displaced" Tibial Plateau

This required surgery to repair the fracture and realign the leg with plates and pins, and to repair the medial collateral to give stability. The PCL has repaird itself, obviously the ACL can't do that, so I currently am without an ACL ligament. (N:B during the injury, it also seems I tore the hamstring (i think its the hamstring that connects at the back of the knee?))

So, pretty horrific all round, but I'm a very fast healer, one of the fastest the surgery / physio team have seen, and if I'm honest, I'm pretty determined / stubborn too. By the end of July I was walking without crutches (bearing in mind a 14week "in cast" period because of the break) and by September I was in the gym.

When I came back to University I hit the gym everyday and pushed myself through the knee pain barrier, spending most of my rehab using a stationary exercise bike for 60mins everyday and once I got a bit bolder building up my jogging capability from 3mins until the point where I was capable of jogging normally. By november 2007, I was discharged from the Physio and Doc.

Later in the year, mid-november I started playing "touch" rugby with friends (basically non-contact rugby) and coped perfectly fine and even had a few kick abouts in football.

Now, all this was quite some time ago, and I'm feeling pretty good about my knee, though I hve to admit it hurts from time to time, or if I twist this way or that, but a lot of it will probably to do with the fact I don't really train for "running" anymore. My capabilities are;

Jogging is totally fine.
Running is totally fine.
Sprinting is fine, BUT, I have an "odd gait" and don't actually manage to sprint, just run in a wider stride, I have no "heel flick" (i dont know this stuff, I have a sprinter friend)
Jumping isn't 100% comfortable, but I havent done any physio on the muscles which jump in the leg so that could possibly be rectified.

Recently I've began to miss sport, in a big way, and my attention has turned back to the possibility of taking up sports again. Now, I was told my only concern would be PTA (post traumatic Athritis?) but that hasnt surfaced and my knee feels strong. So here are the questions I desperately need answering;

Am I in a position to take up sport again in my current physical condition with the aide of knee brace?
If so, which sports?
Would "7's" rugby be possible?


Which brace?

If no, would an ACL recon make it possible?

(I'm sorry for so many questions, it has been a long time since I spoke to anyone about my injury and I'm really anxious to speak to experts about it)

Thank you so, so much.

Dafydd.

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• The Future

[Canuck Physio]

Hey Guys,

This is a pretty comlplex one, and from what I uderstand of the nature of my injury, one for the experts! Around one year ago, (March 2007) I suffered a dislocated right knee playing rugby. This resulted in;

- Medial Collateral Tear
- Poster Cruciate Ligament Tear
- Anterior Cruciate Ligament Tear
- Fractured and "displaced" Tibial Plateau

This required surgery to repair the fracture and realign the leg with plates and pins, and to repair the medial collateral to give stability. The PCL has repaird itself, Great, how well?obviously the ACL can't do that, so I currently am without an ACL ligament. This can be okay, but is there any reason the consultant descided against ACL repair? (N:B during the injury, it also seems I tore the hamstring (i think its the hamstring that connects at the back of the knee?))All hamstrings attached approximately around the back of the knee, specific tests should be used to examine the actual problem

So, pretty horrific all round, but I'm a very fast healer, one of the fastest the surgery / physio team have seen, and if I'm honest, I'm pretty determined / stubborn too. By the end of July I was walking without crutches (bearing in mind a 14week "in cast" period because of the break) and by September I was in the gym.
Great to hear.
When I came back to University I hit the gym everyday and pushed myself through the knee pain barrier, spending most of my rehab using a stationary exercise bike for 60mins everyday and once I got a bit bolder building up my jogging capability from 3mins until the point where I was capable of jogging normally. By november 2007, I was discharged from the Physio and Doc.
Sounds like you have had good progress
Later in the year, mid-november I started playing "touch" rugby with friends (basically non-contact rugby) and coped perfectly fine and even had a few kick abouts in football.
Hmm... did you have an atheletic performance assessment?
Now, all this was quite some time ago, and I'm feeling pretty good about my knee, though I hve to admit it hurts from time to time, or if I twist this way or that, but a lot of it will probably to do with the fact I don't really train for "running" anymore. My capabilities are;

Jogging is totally fine.
Running is totally fine.
Sprinting is fine, BUT, I have an "odd gait" and don't actually manage to sprint, just run in a wider stride, I have no "heel flick" (i dont know this stuff, I have a sprinter friend)
Jumping isn't 100% comfortable, but I havent done any physio on the muscles which jump in the leg so that could possibly be rectified.
Be careful about dynamic or high impact activities, unless you have been specifically assessed and treated for this you are risking injury
Recently I've began to miss sport, in a big way, and my attention has turned back to the possibility of taking up sports again. Now, I was told my only concern would be PTA (post traumatic Athritis?) but that hasnt surfaced and my knee feels strong. So here are the questions I desperately need answering;
Again there should have been significant follow up assessment to rule this out
Am I in a position to take up sport again in my current physical condition with the aide of knee brace?
Be very careful about the idea of using external aides to make up for lack of dynamic stability/knee joint strength etc. Recently there was a Rugby player that came in with a fixed knee flexion after a total knee replacement. After 3 weeks of intensive in-patient physiotherapy he left the ward walking on his own 2 feet. However, significant dysfunction remains. Although he can walk, there is still 'optimizing' to do regarding the knee. The lack of obvious or visual problems is what people tend to regard as reason not to see a physiotherapist, when in fact high-end rehabilitation and sports physiotherapy is actually vital.
If so, which sports?
Entirely depends on level of function.
Would "7's" rugby be possible?
What is 7's? Sorry am a Canuck

Which brace?
Minimal if possible, build up the muscles to be your primary brace, once that is done consider a brace to minimize impact or unalterable forces
If no, would an ACL recon make it possible?
Depends, what was the consultants initial opinion
(I'm sorry for so many questions, it has been a long time since I spoke to anyone about my injury and I'm really anxious to speak to experts about it)
You will find some help here, but the real help occurs in person, hope you find what you need.
Thank you so, so much.

Dafydd.

as above, regards

Additionally, you may want to consider corticosteroid injections if indicated

[feiflyfly]

Hi Dafydd, may i ask what stopped u from doing sport recently??

[Dafydd]

Some Information for previous posts;
- Touch Rugby is basically Rugby but without contact, if you are touched, you stop running and pass the ball.
- I havent played sport because of this injury.
- The ACL was not reconstructed as I had to have 6 pins and a plate attatched to repair the tibial plateau fracture and the bone would not have held up to an ACL graft aswell.

I'm just looking to see, when I get told I am unable to play sports, is it because I do not have an ACL which means no contact, or is it, that even with an acl, the tibial plataeu fracture and massive ligamental damage would mean I shouldnt?

[Canuck Physio]

Some Information for previous posts;
- Touch Rugby is basically Rugby but without contact, if you are touched, you stop running and pass the ball.
- I havent played sport because of this injury.
- The ACL was not reconstructed as I had to have 6 pins and a plate attatched to repair the tibial plateau fracture and the bone would not have held up to an ACL graft aswell.
Ok, have you checked with your consultant if you would benefit from further surgery, or is conservative treatment the best option for you? In that case, you should be personally referred to physiotherapy.
I'm just looking to see, when I get told I am unable to play sports, is it because I do not have an ACL which means no contact, or is it, that even with an acl, the tibial plataeu fracture and massive ligamental damage would mean I shouldnt?
You should be able to play, but you may need necessary precautions such as a protective brace. This will need to be fitted and chosen specifically as a brace is not ideal, but in your case may be useful. Again you need sports specific assessment before going back on the field. As well you will have the increased risk of damage in case of contact, or high intensity or functional power movements on field. These require a great deal of joint stability, and although many people can play well without an ACL, they require a lot of strengthening around the joint to make up for this proprioceptive loss.

as above regards