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Old 12-19-2011, 10:52 AM   #1
Sue Ostrom
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Total knee dislocation ACL/PCL/MCL/Meniscus

4/17/11 49 yr old active female took bad fall in accident where my foot hit a gate and rest of body pulled past leaving my lower leg bent at knee 90 degrees to lateral outside. When I sat up I had to pull lower leg back inline. Would absolutely not support any weight without collapsing outward.
Diagnosis was complete disruption of MCL, ACL and PCL, both menisci were bucket flipped in joint and badly torn. Also hamstring and gastroc muscle tears. LCL was sprained but intact.
On 4/27/11 had surgery for repair of both menisci and MCL replaced with allograph (achilles tendon). Locked straight, nonweight bearing for 6 weeks. Then very subtle PT lying on my stomach w/ assistance in raising foot to get flex. Worked hard in PT to regain flexion and even called a rock star by surgeons who later told me they doubted I would ever walk normal again. I had no problem with extension at close to zero but started with about 55 degree flex after so long in the brace. Surgeons said spend next 6 months getting to 90 degrees and then 115 degrees and they would arrange next surgery. By Oct 2011 I was at 120 degrees extension and was bearing full weight with brace always on and didn't use crutches. Surgeons discussed lifestyle choices and learned I am very active so choice of wearing brace when doing something physical was not practical. My knee was still a 3+ stability front to back with no ACL/PCL so sheduled 12/8/11 surgery for ACL/PCL reconstruction again using allograph. Took MRI prior to 2nd surgery and amazed that both menisci looked very good, one 95% and other normal. I am now 11 days post op from 2nd surgery with knee again locked and non weight bearing for 3 weeks. Then I believe I will be starting the very conservative rehab lying on stomach bending leg with assistance. They do NOT want my hamstring activated for 6 to 8 weeks I suspect.
Does anyone else out there have this substantial multi-ligament injuries to give me advice, hope, healing timeframes and exercises that worked for you?
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Old 12-19-2011, 01:59 PM   #2
Ben Stroud
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Smile Re: Total knee dislocation ACL/PCL/MCL/Meniscus

Hi Sue,
Im in kind of the same boat as I patella tendon, both retinaculum's and some quad partial tears. But yours actually sounds worse! It must have looked worse. My diagnosis was back to work in 6-10 months but full fitness...? I think its down to attitude, not going to hard too soon and nutrition. On the advice of quite a few top level people they have advised me to drink collagen liquid as a base. Good luck and speedy recovery suexxx
Ben
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Old 12-19-2011, 03:47 PM   #3
Steven Low
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Re: Total knee dislocation ACL/PCL/MCL/Meniscus

Wow, I've never seen anything like that before.

To be honest though it sounds like you are doing exceptionally well.... just take one surgery and rehab one step at a time.

As you saw, even for your age you made a great recovery from the previous and if you keep plugging you should be able to make a good recovery from this one too given that you are active.

Just listen to your PT and your docs!
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Old 12-20-2011, 08:50 AM   #4
Ari Sherwood
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Re: Total knee dislocation ACL/PCL/MCL/Meniscus

Wow, that's quite a history. Truly the "unhappy triad", as I've heard it called. But at least your menisci are in good shape!

Sounds like you're taking it all in stride and working hard on recovery, which is great. Keep on doing what you're doing and listen to your OS/PT.

Just curious - why are you non-weight bearing for 3 weeks? When I had my ACL recon and had my mensicus trimmed at the same time, I was weight bearing within a few days. Given your mensicus is intact, I'm surprised they wouldn't let you bear weight, especially if you were stable before recon.

Also, I'm curious about them keeping you from activating your hammie. Is this because of the PCL recon? I thought hammie activation was more of an issue for people who have a hamstring autograft, not an allograft.

Good luck with the continued recovery!
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Old 12-20-2011, 03:11 PM   #5
Steven Low
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Re: Total knee dislocation ACL/PCL/MCL/Meniscus

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Originally Posted by Ari Sherwood View Post
Wow, that's quite a history. Truly the "unhappy triad", as I've heard it called. But at least your menisci are in good shape!

Sounds like you're taking it all in stride and working hard on recovery, which is great. Keep on doing what you're doing and listen to your OS/PT.

Just curious - why are you non-weight bearing for 3 weeks? When I had my ACL recon and had my mensicus trimmed at the same time, I was weight bearing within a few days. Given your mensicus is intact, I'm surprised they wouldn't let you bear weight, especially if you were stable before recon.

Also, I'm curious about them keeping you from activating your hammie. Is this because of the PCL recon? I thought hammie activation was more of an issue for people who have a hamstring autograft, not an allograft.

Good luck with the continued recovery!
Some docs are super conservative about when they weight bearing and when they want rehab to start and whatnot. I think the literature is starting to show that early WB and mobility, if safe, is good. But docs are allowed to do what they want for that

PCL is no hammies for a while.

Just like ACL they don't want any OKC quad activity in the 0-45 deg range and no CKC >60 deg for a couple weeks as puts stress on fragile ligaments (I think those numbers are correct... they might be off though just FYI)
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Old 12-21-2011, 08:28 AM   #6
Ari Sherwood
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Re: Total knee dislocation ACL/PCL/MCL/Meniscus

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Originally Posted by Steven Low View Post
Some docs are super conservative about when they weight bearing and when they want rehab to start and whatnot. I think the literature is starting to show that early WB and mobility, if safe, is good. But docs are allowed to do what they want for that

PCL is no hammies for a while.

Just like ACL they don't want any OKC quad activity in the 0-45 deg range and no CKC >60 deg for a couple weeks as puts stress on fragile ligaments (I think those numbers are correct... they might be off though just FYI)
Ah, gotcha. Thanks.
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Old 12-21-2011, 09:36 AM   #7
Sue Ostrom
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Re: Total knee dislocation ACL/PCL/MCL/Meniscus

Thanks for the words of support. I met w/ surgeon yesterday 12 days post op from ACL/PCL reconstruction. By the way, I am being treated by Mayo Clinic Rochester's top two multiligament reconstruction specialists. My surgeon yesterday disclosed that he hadn't expected to need to do my 2nd surgery as the April surgery to repair MCL/meniscus reconstruct would have likely left my leg so stiff that physical activity would be limited by scar tissue making next repair unnecessary. He loves what has happened in the healing (even calls me a rockstar with a miracle knee) and now feels I am moving toward a much more complete recovery. He called this injury the worst medial side knee injury he has seen.
Very conservative followup now. At 3 weeks I will start the PT of flexing my knee while on my stomach. No hamstring activation is to protect my PCL allograph. Now I think I will be non weight bearing 6 or more weeks. They don't want my tibia to shift back or damage to PCL. Also said he does not want me to bend anymore than 90 degrees before 3 months. He wants me to let allographs heal and not push due to so much reconstruction. Seems crazy when the normal is to push to get that flexion back. I was even told to avoid quad sets as he doesn't want my tibia rotating back. He really focuses on avoiding tibia movement until things firm up. Only time I take brace off since surgery is to shower and knee range now is probably zero to 40 degrees. My only PT is straight leg lifts which are easy so keeping my quad strong still and lots of foot pumps. Its going to be a long January and beyond. Pain is minimal and not taking oxycodone by 7 days post op.
From where I started and where I am at now, I would highly recommend my Mayo Rochester surgeons. Not sure if names can be used here but if anyone wants their names let me know.
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