PCL tear - Aussie Rules footie player

Case Study:

22 year old male attended physiotherapy clinic complaining of a 3-4 week history of a sudden onset of left knee posterior pain, referring into the lateral gastrocnemius calf.  He is able to walk painfree but has difficulty with full flexion, squatting and kneeling.  He is unable to recall the exact mechanism of injury but remembers pushing off suddenly to jump for the ball and then being tackled by the opposition.  There was minimal swelling present.  He continues to work full time as a painter.  He is unable to run due to the feeling of giving way.  He does not report any locking.

Clinical Examination

There is minimal swelling.  On testing ROM, he has almost full flexion with both active and passive movement, with a springy end feel on the left.  There is full extension with mild discomfort posteriorly.  Quads and hamstring isometric testing is 5/5 and painfree.  On palpation, there is some tenderness over the mid-distal fibres of the MCL but nil into the medial joint line.  There is mild laxity on valgus stress at both 30 and 0 degrees.  On testing ACL, there is a true end feel.  On testing PCL, there is significant laxity with posterior drawer.  There is minimal sulcus on gravity assisted posterior drawer.  Meniscal testing is positive for the lateral posterior horn on the left.

Clinical Diagnosis

PCL tear (grade II) with likely lateral meniscal tear to the posterior horn (minimal swelling due to the PCL being extrasynovial)

MCL grade I sprain

Treatment

This patient has been sent for an MRI scan to assess the extent of damage.  He declined a hinged knee brace and has been recommended to avoid all high impact activity.  He is aware that surgery may be required but PCL can also be conservatively managed with good prognosis.  He will be reviewed in-rooms for 6-12 week strengthening regime, focussing primarly on quad control.