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Celtics’ Kendrick Perkins Out for Game 7

Boston fans witnessed a devastating injury to Celtics player Kendrick Perkins on Tuesday night when he sustained a right knee injury (watch the video http://www.youtube.com/watch?v=k4geaMUOX3w).  While landing on his right leg in the first quarter, he fell to the ground crutching at his knee.  An MRI of his right knee will be performed in Boston on Friday, but he has a medial collateral ligament (MCL) tear and a partial posterior cruciate ligament (PCL) tear.  He is not expected to play in Game 7, the deciding game of the NBA Finals.

ANATOMY

The knee is a complex joint, with four main ligaments that stabilize the joint: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) tear, and the medial collateral ligament (MCL).  Together, these four ligaments help to stabilize the knee in all planes of motion.

The MCL is on the inner part of the knee joint. It starts at the thigh/femur bone and ends in the leg/tibial bone.  Part of the MCL attaches to the medial meniscus, a cartilage disc that acts as a cushion on the inner part of the knee.  The main function of the MCL is to prevent the knee from buckling inwards.

The PCL is lives inside the knee.  It starts from the thigh/femur and ends in the back part of the leg/tibia bone.  The main function of the PCL is to prevent the leg/tibia bone from moving behind the thigh/femur bone.  It also has components that help to act as a secondary stabilizer to the knee bucking inwards, outwards, or in external rotation.

PCLSYMPTOMS AND CAUSES

The MCL is usually torn by a blow to the outer part of the knee.  The inner part of the knee gaps open and the MCL can tear.  Typically the tear of the MCL is associated with an ACL or meniscal tear.  The patients experience pain over the MCL, swelling, bruising, and possibly instability.  There are 3 grades of an MCL tear:

Grade 1 – This is a partial tear.  Patients may have few symptoms that do not last a long time.  These athletes may miss one to two weeks of athletic activities.

Grade 2 – This is also a partial tear, but these patients have some instability, especially with cutting and pivoting motions.  The return to sports is four to six weeks after the injury.

Grade 3 – This is a complete tear of the MCL.  There is instability, a lot of pain, and swelling.  These athletes usually need a brace for protection of the knee while the MCL heals.  Recovery can take six to twelve weeks.

The PCL is torn when the leg/tibia bone is forced back, such as a dashboard injury.  These patients usually have pain, swelling/an effusion, and limited range of motion of the knee.  These individuals will complain of an unstable knee that will “give out.”  There are 3 grades of a PCL tear:

Grade 1 – This is a partial tear of the PCL.

Grade 2 – This is a complete, isolated tear of the PCL.

Grade 3 – This is a complete tear of the PCL with an associated ligament injury.

TREATMENTS

An isolated injury to the MCL can usually be treated without surgery.  Grade 1 tears can be placed in a knee sleeve, given anti-inflammatories for pain control, and a perid of rest.  Grade 2 and 3 injuries usually require a hinged knee brace.  Grade 3 injuries usually need a period of nonweightbearing.    If there is an associated injury, such as an ACL tear, PCL tear, or meniscal tear, surgery may be necessary.

Treatment for PCL tears is controversial.  Grade 1 and 2 tears are usually treated without surgery.  Physical therapy is required to regain range of motion and strength of the knee, thereby restoring stability to the knee.  Grade 3 injuries usually require surgery, with reconstruction of the PCL.

WHEN TO SEEK MEDICAL ATTENTION

If you suspect that you have sustained an MCL or PCL injury, you should seek the advice of a medical professional.

May the best team win Game 7.

Dr. P

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All material published through this blog/website is for informational and entertainment purposes only. Readers are encouraged to confirm the information contained herein with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by physicians. Dr. Parekh and Duke University will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising from the discussions in this blog.

Locations

  • N.C. Orthopaedic Clinic
  • Durham Regional Hospital
  • Davis Ambulatory Surgery Center
  • Duke Hospital North
  • Duke Ambulatory Surgery Center

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