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Rebound® PCL Case Study

24 year old male, right knee isolated high grade PCL injury, non-surgical treatment

Christos Kondogiannis
FAOrthA FRACS

Royal Melbourne Hospital St. Vincent’s Private Hospitals

Melbourne, VIC Australia

Indication

24 Male, High Level AFL footballer with Right Knee isolated high grade PCL injury after fall onto anterior tibia on a flexed knee. Seen Day 7 post injury with Grade 3 PCL laxity (tibial station posterior to femoral condyle). No other clinical laxity. Past History 2 years prior of Left knee high grade PCL injury, managed without bracing, with Grade 2+ Posterior Draw with firm end point.

Diagnostics

No fractures on plain x-ay. MRI confirmed midsubstance PCL injury. No associated meniscal or chondral injury. Intact Posterolateral Corner, ACL and MCL.

Treatment Overview / Treatment Goal

Patient reported mild dissatisfaction with residual laxity on left side. After discussion of options, patient elected to be managed with Hinged PCL Specific Brace, with the goal of reduced laxity when compared to previously injured Left knee.

Non-surgical Treatment/Rehabilitation

Item Phase 1
(0-2W)
Phase 2
(2-8W)
Phase 3
(8-12W)
Phase 4
(>12W)
Rebound PCL 24 hours 24 hours Day only No brace
ROM (Ext/Min
Flex/Max Flex)
Locked in extension 0/0/45 week 2-4
0/0/90 week 4-6
0/0/max week 6-8
No limitation
Weight Bearing 25% PWB 50% PWB week 2-4
WBAT > week 4
No limitation
Physical Therapy RICE
Isometric
Contractions
RICE
Closed chain
Hamstring exercise
Proprioception
Graduated return to sport specific training/agility Return to Sport

Reasons To Use The Rebound PCL Brace

Despite literature supporting functional rehabilitation without bracing for isolated high grade PCL injuries, in my experience, not uncommonly, patients note residual posterior laxity that is problematic. This patient in particular had experienced a similar injury of the contralateral knee, and whilst still functioning at a high level, noted residual symptoms. Previous satisfactory outcomes with the use of PCL braces lead me to offer bracing as a treatment option in this case. We were fortunate that the injury occurred at a time where the athlete felt comfortable taking time before returning to competition.

Clinical Outcome

The patient returned to high level competition approximately 4 months post injury, at the beginning of the next season. Examination of Right knee at 6 months revealed grade 1 posterior draw, with firm end point. ROM equivalent to contralateral knee. Subjectively, the patient was much happier with his right knee stability than his left knee. As noted previously, despite subjective dissatisfaction with his left knee, athletic performance was not adversely affected.

Conclusion

In this isolated case, use of a specific PCL brace resulted in an improvement in PCL stability from baseline, and subjective satisfaction for the patient.

Rebound® PCL

The world’s first dynamic force PCL brace and winner of the 2016 Sports Medicine Awards from Orthopedics This Week. The Rebound PCL is designed to reduce load on the PCL by applying a physiologically correct force, optimum for rehabilitation of posterior cruciate ligament (PCL) ruptures and complex ligament reconstruction with PCL injury.

  • Dynamic Tension SystemTM
  • Polycentric Hinge
  • Anti-migration Straps (AMS)
  • Breathable Sensil® liners

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