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Injury
Occurred during Taekwondo strength training - Plyometric box jumps
- Fall during jump, knee forced into flexion as it hit the edge of the wooden box
- Symptoms: instant swelling, no "pop" sound as is common with an ACL tear, inability to fully weight bear (training stopped and ice applied) -
Walk-in Clinic
- Woke up unable to walk without crutches after having taken part in a sparring session the evening before
- Physician ordered an X-Ray scan. Nothing detected. Told to "use my common sense" in returning to training.
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McGill Sports Clinic
- Manual tests including posterior drawer (tibial sag observed from the side)
- Accumulation of fluid and significant swelling
- ROM impaired
- Physician ordered an MRI: r/o meniscal tear, ACL/PCL
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MRI Scan
- at the Westmount Square Medical Imaging
- private sector to accelerate test and results, with the objective of participating in Nationals in January and the US Open in February
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MRI Results
- Isolated grade 3 partial tear of PCL (equivalent to complete tear)
- All other ligaments appear intact, as well as both menisci
- Prognosis: return to competition within 6 months with conventional treatment (physiotherapy)
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Period: to
Physiotherapy
at McGill Sports Clinic
- Including transcutaneous electrical nerve stimulation (TENS), stability exercises
- Focus on reducing swelling and diminishing pain felt with hamstrings activation against resistance (hamstring curl)
- Approval not given to return to competition -
Period: to
Weight training and occasional Taekwondo training
- including a training camp in Mexico from March 3rd to 14th;
- performance greatly hindered and training often limited to the use of the other leg only
- weight training includes lower body work aimed at gaining stability and maintaining strength (not gaining), leg press limited to 90° angle
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Physiotherapy failed to alleviate symptoms
- unable to resume full activity due to recurring acute pain during training
- swelling reduced completely
- not eligible for BIODEX evaluation due to persistent pain with resistance
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Referral to surgeon for consultation
Physician believes a surgical intervention is unlikely -
Orthopedic Surgeon: Reconstructive surgery required
Surgical procedure needed to reconstruct the PCL and posterolaterol corner (PLC) -» Prognosis: full recovery, extensive rehabilition doubled in length in comparison to a standard ACL or combined ACL/MCL reconstruction (i.e. if athletes are cleared after 6 months for an ACL, expect 1 year for a PCL/LCL) -
Date confirmed for surgery: May 1st 2013
projected length of procedure: 4 hours, same day admission -
SURGERY
- 6.5 hour procedure: PCL reconstruction, LCL reconstruction, Lateral and medial meniscal repair
- Achilles tendon allograph used
- 1 night stay: allergic reaction to morphine)
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Period: to
Non weight bearing (NWB) for 6 weeks
- with crutches and Zimmer brace
- brace to be worn while sleeping with leg elevated (to prevent sag and help reduce swelling) for approx. the first 4 weeks
- unable to sleep more than 4-5 hours a night for the first couple of weeks due to incomfort of sleeping on back with leg elevated, and increasing pain from the wearing off of the nerve block over the first few days
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Dismissed from Hospital
- w/ nerve block, oxycodone and novo-gesic
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Beginning of physiotherapy
2x / week at the Montreal General Hospital: Increase ROM and muscle strength, Exercises to be repeated several times a day followed by ice -
Cessation of pain medication
except for physiotherapy exercises -
Trip to Emergency: Suspected blood clots
Ultrasound didn't reveal any blood clots. -
2 weeks post-op: follow-up with surgeon
ROM: 55°, NWB, Cessation of all pain medication (only novo-gesic for physiotherapy), Removal of staples and stitches -» 4 more weeks of NWB followed by weight bearing as tolerated (WBAT) with crutches and hinged brace -
6 weeks post-op: Beginning of WBAT
weight bearing as tolerated, with Zimmer brace due to lack of knee stability and quad strength -
8 weeks post-op: follow-up with surgeon
- PT Evaluation (June 19th): ROM: 105° (strength) / 120° (passive), WBAT with crutches and Zimmer brace, 35% weight bearing, unstable at 50%
- MD's comments: on schedule, but not ahead. Progress ROM to 125° on my own by the end of August (2 months) and wean off crutches within the next week; begin use of hinged brace and continue sleeping with Zimmer as needed
