So I got some bad news today when I went to the Stone Clinic for a second opinion on my knee injury. This follows some pain and swelling after PT, as well as some continued instability and pain. I was prepared to get bad news on the ACL , but I apparently have a major injury in the posterior lateral corner (also called posterolateral or PLC), as well as a functional full tear of the ACL. It's not easy to see on MRI, but clinical tests as well as x-rays under tension showed it. The doctor showed me the relatively extreme rotary mobility of the left knee compared to my right, and it makes sense since it's been the primary area I've felt pain in. Missed PLC injuries are apparently one of the primary causes of ACL graft failure. The good news is that it can be fixed at the same time as the ACL, the bad news is that it is a complicated procedure that very few surgeons are experienced in. I've looked on the kneeguru website and there are no recommended surgeons even in my state! It's also a tougher recovery (full brace, non-weightbearing for 6-8 weeks). And it leaves a big scar. I'm feeling very down. Anyone with any experience with this injury or words of wisdom?
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And it gets worse - ACL plus PLC
- Thread starter valli
- Start date
MaineSkiLady
Angel Diva
Oh, man - what a bummer. 
Really sorry to read this.
I just looked at knee guru website, just to see what was up with surgeon recommendations. Okay, don't be reliant on this site. For my state, they do NOT include one of the best surgeons in New England! (who has done 3 knees in my family) They DO include a surgeon who didn't do a stellar job with someone I know. So this isn't altogether an exhaustive source.
You might want to call Steadman Clinic in CO for CA input? There has to be a top-notch knee surgeon in your region, at least one that rotates in the U.S. Ski Team representation.
MUCH luck! Sounds awful.
Really sorry to read this.I just looked at knee guru website, just to see what was up with surgeon recommendations. Okay, don't be reliant on this site. For my state, they do NOT include one of the best surgeons in New England! (who has done 3 knees in my family) They DO include a surgeon who didn't do a stellar job with someone I know. So this isn't altogether an exhaustive source.
You might want to call Steadman Clinic in CO for CA input? There has to be a top-notch knee surgeon in your region, at least one that rotates in the U.S. Ski Team representation.
MUCH luck! Sounds awful.
Oh, man. I'm so sorry to read this. Given what you wrote about unidentified PLC injuries being the primary reason for ACL graft failures, though, it's small comfort that the PLC injury was noticed.
No other words of wisdom here, other than it's understandable to feel down about this kind of news. Give yourself time to lament and make decisions on your own terms.
No other words of wisdom here, other than it's understandable to feel down about this kind of news. Give yourself time to lament and make decisions on your own terms.
MaineSkiLady
Angel Diva
https://www.americatop10.com/california/san-francisco/top10/orthopedic-surgeons
Might be worth a hunt for bios?
Might be worth a hunt for bios?
VickiK
Ski Diva Extraordinaire
Valli, I'm sorry to hear this. It sounds like you're in northern Calif. Just fyi, here's an orthopedic in southern Calif with two knee specialists: https://www.memorialorthopaedic.com/. I saw Dr. Warden for a bad MCL sprain two years ago. No surgery was needed. Dr. Kurzweil is also recommended, good results for ACL surgery from a friend of a friend.
Well, I talked to Dr. LaPrade's assistant at the Steadman clinic today and she was very nice. She said there isn't currently anyone in California they can recommend for PLC injuries, although there are in other states. She said if I fedexed her my MRI he would look at it on Monday. She said if it's a PLC injury he prefers to treat them early, because scar tissue sets up, so they could schedule me for the following week if he thought it was more than a simple ACL tear.
I saw a third knee specialist this morning, one I had scheduled two weeks ago that came highly recommended by my regular doctor, and he said it's hard to tell if there is a PLC injury or not because I'm so hypermobile. He said he has repaired or reconstructed a few of them, but doesn't see them that often. He recommended doing an ACL reconstruction, looking at the PLC area arthoscopically, and then deciding while I'm in surgery if it needs to be fixed, although he thought it won't. Now I've seen three highly recommended knee experts, and all three have different opinions, although they all think the ACL needs to be fixed. I'm obsessed and confused, maybe I should start a blog entitled, All About My Knee. Thank you all for bearing with me.
I saw a third knee specialist this morning, one I had scheduled two weeks ago that came highly recommended by my regular doctor, and he said it's hard to tell if there is a PLC injury or not because I'm so hypermobile. He said he has repaired or reconstructed a few of them, but doesn't see them that often. He recommended doing an ACL reconstruction, looking at the PLC area arthoscopically, and then deciding while I'm in surgery if it needs to be fixed, although he thought it won't. Now I've seen three highly recommended knee experts, and all three have different opinions, although they all think the ACL needs to be fixed. I'm obsessed and confused, maybe I should start a blog entitled, All About My Knee. Thank you all for bearing with me.
In fairness to all the MDs you've seen, no one will really know what's going on until he or she gets in there. Medical imaging is advanced, but it's still imaging.
mahgnillig
Ski Diva Extraordinaire
Sorry to hear about your knee issues Valli :( If it's any help, I keep consoling my hubby, who also just injured his knee (ortho appointment this afternoon to determine the extent of the injury), that there are plenty of summer activities out there that are less stressful on the knees than skiing, and by next ski season he will be raring to go. It sucks, but at least it's the end of the season and not the beginning.
Agreed.
It makes sense they won't know fully until they get in there, but I was concerned when the local knee specialist said he had done a few, and "if anyone else has done more they are over diagnosing them." Oh, the ego of these guys. Surgeons are bad, but knee surgeons seem to take it to a whole new level. He also wasn't sure what the rehab protocol would be (usually different for PLC than ACL), and from what I've read the surgery protocol is to fix the PLC and then the ACL if done in the same surgery. Somehow doing the ACL first pulls things out of whack for the more delicate PLC reconstruction.
Dr. LaPrade at Steadman reviewed my MRI this morning, and said the ACL is definitely torn, and that it looks like the posterolateral corner may be damaged as well, although he would like to do a clinical exam to confirm. Unlike ACL's, which can wait, his assistant says he prefers to operate on the PLC as soon as possible before scar tissue sets up. That is consistent with everything ive read in the clinical literature from several sources.
Is the Steadman Clinic really that good? Does anyone here know anything about it? I suppose DH and the girls could go skiing at Vail while I recuperate, since we'd have to spend a week there. I also have an appointment next tues with the Stanford doc who trained at Steadman, and that would certainly be easier. The complicated thing is that these injuries are the rarest type of knee injuries, so not that many doctors seem to treat or even recognize them.
Dr. LaPrade at Steadman reviewed my MRI this morning, and said the ACL is definitely torn, and that it looks like the posterolateral corner may be damaged as well, although he would like to do a clinical exam to confirm. Unlike ACL's, which can wait, his assistant says he prefers to operate on the PLC as soon as possible before scar tissue sets up. That is consistent with everything ive read in the clinical literature from several sources.
Is the Steadman Clinic really that good? Does anyone here know anything about it? I suppose DH and the girls could go skiing at Vail while I recuperate, since we'd have to spend a week there. I also have an appointment next tues with the Stanford doc who trained at Steadman, and that would certainly be easier. The complicated thing is that these injuries are the rarest type of knee injuries, so not that many doctors seem to treat or even recognize them.
RX2SKI
Certified Ski Diva
Here's info from one of the docs at Steadman's Clinic that focuses on PLC injuries:
https://drrobertlaprademd.com/aaos-...r-laprade-and-colleagues-on-plc-knee-injuries
Shedding Light on the “Dark Side”of the Knee
https://www.aaos.org/news/aaosnow/feb13/research6.asp
https://drrobertlaprademd.com/aaos-...r-laprade-and-colleagues-on-plc-knee-injuries
Shedding Light on the “Dark Side”of the Knee
https://www.aaos.org/news/aaosnow/feb13/research6.asp
