Tag: brace

Brace yourself… You might need surgery

A surgery? For my PCL? Could be more likely than you think.

Usually hiding behind it’s annoying and commonly ruptured brother the ACL, the PCL (posterior cruciate ligament) is a durable ligament that usually doesn’t cause problems for athletes… until it does.

Because of the strong nature of the ligament, injuries that tear the PCL are usually sudden and traumatic. Think car accidents, falling hard on a bent knee… you get the picture. When enough force is applied to the top of the tibia, the tibia can be pushed backwards, past the threshold of the PCL. Even though the PCL does its best to hold your femur and tibia together in the right spot, it just doesn’t hold up to the brute force of a dashboard. These injuries can usually be diagnosed by the presence of a “sag.” When your doctor holds your bent knee up, it looks like your shin bone is sagging underneath your knee. This is your torn PCL crying for aid.

A photo showing the location of the PCL and ACL inside of the right knee. The ACL crosses from left to right over the PCL. Both are attached at the top to the femur and at the bottom to the tibia.

When it comes to fixing these injuries, the nonsurgical approach has typically been recommended for low-grade tears that don’t totally rip the PCL apart. These braces are attached to the leg right above the knee, and are supposed to hold the bottom part of your leg under the knee in place. This prevents from your knee from going too far forwards and backwards, and allows scar tissue to build up over your PCL. While your body tries to heal itself with scar tissue, you will work with a physical therapist to build up your quad strength and restore your range of motion. Over 80% of athletes are able to return to play after bracing their knees.

A PCL brace is shown in place on a knee. There are two stabilizing straps above the knee, and two below the knee. They are connected by a metal frame that meets at a hinge joint over the side of the knee.

However, surgery, which was once only reserved for extreme PCL tears, is now seen as a viable, cost-efficient option for even low-grade tears. PCL surgery is intended to restore normal knee biomechanics and stability to about 90% of their post-injury strength. Sometimes, a part of the Achilles tendon is used to create a graft, or a “new” PCL. This is called an allograft, and results in safer and shorter surgeries (8). Within a month, the athlete can walk and bear their own weight. After six months, athletes are able to return to sports.

In theory, surgery sounds like the most “permanently good” option there is for fixing your PCL. However, no scientific studies have yet been done that can accurately compare the return-to-play rates, or even the relative healing of people in braces versus people who immediately got surgery. When people don’t comply with their treatment plans (aka, take off their braces early, skip physical therapy after surgery, etc.) the data for comparisons between bracing and getting surgery aren’t clear. While your PCL may be out of commission, so is the jury on this one. At the end of the day, the best treatment method for you is dependent on the mechanism of injury, severity of your injury, and whether you plan on listening to your doctor or not!

For more info on PCLs:

Posterior Cruciate Ligament Injury

Management of PCL tears

Do Wrist Guards Prevent Snowboarding Injuries?

Snowboarder grabbing board while in the air after going off a jump.
Photo from Markos Mant on Unsplash

Snowboarding is a breathtaking sport yet carries with it an inherent risk of injury. Wrist protectors provide potential protection against snowboarding wrist injuries. However, some studies have argued that wrist protection transfers the injury to other parts of the forearm.

A 2001 joint study by the Lillehammer Central Hospital (Now part of Innlandet Hospital Trust) and University of Oslo Department of Orthopedic Surgery explored the efficacy of wrist protectors in preventing snowboarding injuries.

Studies like this are very important in growing winter sports, as more athletes will pick up snowboarding or alpine skiing if the risk of serious injury can be further decreased.

A total of 5029 snowboarders were included in the study, with 2515 snowboarders wearing a brace and 2514 snowboarders not wearing a brace. The brace used was a D-ring wrist brace. A physician examined the participants at the end of each day snowboarding and was not aware if the subject had worn a wrist protector or not. The physician defined a wrist injury as an evident fracture, sprain, or pain in the wrist that lasted for at least 3 days.

Front and Side view of a participant wearing a D-ring wrist brace.
Front (A) and side (B) views of D-ring Wrist Protector. Modified from Rønning, Rønning, Gerner, and Engebretsen, The American Journal of Sports Medicine 2001

A limitation of this study comes with setting an endpoint for what qualifies as a wrist injury. Both fractures and sprains qualify as wrist injuries. Wrist pain must be accompanied by decreased range of motion for 3 days to qualify as a meaningful wrist injury.

The study results showed that the braced group experienced 8 wrist injuries, while the control group recorded 29 wrist injuries. This is a statistically significant difference in the number of wrist injuries experienced by each group.

Of the subgroups explored in this study, beginner snowboarders with less than 5 days of snowboarding experience were found to have significantly more wrist injuries than the snowboarders with more than 5 or more days of experience.

A snowboard constrains both legs and feet in strapped bindings. When a snowboarder begins to lose their balance, a snowboarder will commonly extend their arms to brace the fall. When the wrist is flexed upwards during a fall, the wrist absorbs the energy of the fall and causes a fracture or sprain.

An effective wrist protector absorbs as much energy as possible without providing additional stress areas to the forearm. A wrist protector that is designed with too much rigidity will generate a high stress force above or below the wrist. The study confirms the benefits of wearing a protective wrist guard while snowboarding, and the physician found no injuries in the arm due to the use of a brace.

However, most wrist guards still available are uncomfortable to wear with winter gloves, so the study recommended future gloves be designed with built-in wrist guards. By improving the safety of alpine sports, snowboarders will feel comfortable pushing the boundaries of the sport and attempting more unforgettable tricks!

For more on injury prevention in snowboarding, check out this article by the Daily Herald or click here.