Posterior Cruciate Ligament Injury
What can we learn from footballer Zlatan Ibrahimović’s knee injury in 2017? Focus on Posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) implications
The PCL is broader and stronger than the ACL, and has a tensile strength of 2000 Newtons – meaning injuring it requires a lot of force. Injury most often occurs when a force is applied to the front of the shin at the top when the knee is bent due to this, PCL injuries are most commonly seen in high impact car collisions. However, due to the anatomy of the knee, hyperextension (over straightening) and rotational forces, or forces in or out against the knee also may be responsible for PCL tears.
Start with a sports person
If we start with a sports person who has suffered an isolated mild to moderate (Grade I-II) PCL injury, we find they can do well with quality physiotherapy rehabilitation because surgical reconstruction tends to improve the instability but it does not provide a normal knee. Most isolated Grade III tears can be treated non-operatively using a specially designed PCL brace that holds the shin bone in a forward-reduced position that gives the PCL an opportunity to heal. Unlike the common ACL tear, acute isolated PCL injuries can heal.
Unfortunately, Zlatan appears to have both an ACL and a PCL tear.
The case at hand
This injury was NOT an isolated PCL injury. Media reports suggest Ibrahimović also had an ACL injury (with the possibility of further damage not being mentioned but still present). A multi-ligament injury has the potential of neuromuscular injury which, when present, has an ominous prognosis. Even without that complication, the prognosis must be very guarded for an elite level football player to return to the demands of high level play with an ACL/ PCL reconstruction.
When we see similar patients is to ensure they have a stable knee they can walk on and live with. There are anecdotal reports of athletes returning to play after multiple ligament knee reconstruction but when scrutinised, the players are usually the slower lumbering players like an American football lineman — not players whose success relies on them being quick and agile.
It’s important for us, as clinicians, to spend lots of time explaining prognosis to people who suffer serious injury and the rehabilitation team which includes Doctors, coaches, and parents in the case of juveniles, must communicate well and work together.
Source: 26 Apr, 17 | BJSM Blog by Prof. Karim Khan
Focus on Kim – nutritional therapist
Kim has now been working in clinic full time for nearly three years, after having completed a twelve year stint at Solgar UK Vitamin & Herb, travelling the UK and Ireland delivering lectures and running training workshops as well as seeing patients in many different clinics.
Therapy focus points
This year Kim’s main focus has been on understanding and evaluating the new DNA sequencing methods used by specific labs. This new technology enables us to look at our gut bacteria in much more detail and means we can be more specific with treatment plans.
In clinic we provide full clinical testing using the Genova “GI effects stool analysis profile” and more recently “Map my gut” both of which were featured in “Doctor in the house” on BBC 1 on 22nd May and available on BBC iPlayer.
This new diagnostic tool
We are not only able to see how healthy our gut bacteria is in terms of abundance and diversity, but it enables us to look at inflammation, immunology digestion and absorption, which traditional gastroenterology investigations quite often do not pick up.
Kim wants to explore the practical application of these methods in finding solutions to chronic long term conditions such as irritable bowel syndrome, diverticulitis, ulcerative colitis and crohns disease, type two diabetes, anxiety disorders and even obesity.