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I am an orthopedic physical therapist working in a sports medicine clinic. We just had an unusual referral for a 12-year-old-boy who had a soccer injury. The diagnosis is peel-off injury. Do you have any guidelines for post-op treatment for this type of injury?
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A peel-off injury refers to tearing away of the posterior cruciate ligament (PCL) from the tibia (lower leg bone), one of the places where it attaches. Another term for this type of injury is tibial avulsion of the PCL.
As with your patient, the typical person affected is a boy between the ages of 12 and 13. These injuries occur most often during soccer, basketball, dodge ball, or as a result of a fall.
It's a fairly uncommon injury so large studies comparing the results of treatment are not available. In fact, most studies are just case reports of a single patient or small number of cases presented together.
A recent report from orthopedic surgeons in Korea who treated six boys with this problem reported their postoperative physical therapy program. Their protocol starts right after surgery. The children are kept in a hinged, long-leg brace locked in a fully extended position for four weeks. This approach of immobility is designed to protect the healing ligament. Quadriceps strengthening exercises are allowed with the leg in the brace.
At the end of the four-week period of time, the brace is unlocked and passive movement is allowed. The child is allowed to put gradual, increasing amounts of weight on the leg until the brace is removed eight weeks after surgery. All activities are resumed as the child is able to perform them. Sports activity are allowed when motion and strength are within normal limits.
It might be a good idea to submit your plan of care to the surgeon for a quick review and approval. The child in question may have some specific needs that your evaluation will uncover. And the surgeon may have some directives once he or she sees the proposed plan in writing. Good luck!
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