Darwin Barney's Pacific Coast League (PCL) Sprain
Darwin Barney went on the DL this week spraining "the other" cruciate or Posterior Cruciate knee ligament. I'm sure the Cubs called Iowa Cubs manager Bill Dancy to let him know that his Pacific Coast League (PCL) Iowa team might shortly be getting another middle infielder on rehab assignment for his lineup. Barney sustained the injury to his right knee on the play at home plate on Monday night, scoring the Cubs only run in a 1-0 victory. It looked like he bounced his knee in the dirt during a head first dive and he did stumble a bit getting up from his dive. The MRI showed injury without stretch (grade 1) to his Posterior Cruciate Ligament (PCL). This is considered fairly minor but probably needs to be protected from further injury for about 2-3 weeks.
"As soon as I slid into home plate last night, I knew something was really wrong," he said. "The whole knee went numb. I had an MRI today and it revealed that Grade 1 strain in my knee." (editiorial note: ligament injuries are sprains, muscle injuries are strains)
Right now Darwin Barney can't jump, but you can. So read more after the jump.
There has been plenty of media attention paid to the Anterior Cruciate Ligament (ACL) which when torn in a high performance athlete is treated with reconstructive surgery but little is written about in the media when the posterior cruciate ligament (PCL) is injured. The Posterior Cruciate is structurally the more robust of the two cruciates and isolated PCL injuries can occur but are less frequent and usually produce more subtle symptoms. If both the Anterior and Posterior Cruciates are torn, more drastic instability can occur including knee dislocation but fortunately that is not very common. Most people hear about the fairly common patella (kneecap) dislocation but a true knee dislocation (tibia-femur) is a severe injury and acute knee dislocations can even have nerve and artery damage.
The PCL attaches behind the knee on the tibia and goes to the medial (inner) side of the central notch on the femur. The ligament prevents posterior translation of the tibia relative to the femur above and also provides central rotational stability. Here is an excellent 3D modeling video of the PCL including how the ligament works in flexion and extension of the knee. The Anterior Cruciate (ACL) attaches to the anterior tibial spine near the front of the knee and goes to the lateral (outer) part of the femoral notch. The ligaments cross (hence, cruciate) each other and protect and stabilize the knee when working in tandem from excess rotation and translation.
Before MRI imaging was available, grade 2 vs 3 PCL injuries were sometimes subtle to diagnose on exam with what was called a "posterior sag" sign with the knee extended or a "posterior drawer" sign with the knee flexed. The PCL does image well on MRI studies (see "P" on image), so seeing injury to it (because the tissue signal is altered in injury) is straightforward making even subtle grade 1 injuries possible to diagnose these days.
The most common mechanism of injury is a direct blow to the front of the upper tibia, which is what seemed to happen to Barney's leg in the head first dive at home plate.
Certainly, a grade 1 strain should respond to rest and rehab in a few weeks but when the PCL has a third degree injury and the knee has instability there are arthroscopically assisted surgical reconstructive techniques (see video) available. These have evolved and are significantly improved over the last 2 decades and much of the technology has been based on arthroscopic considerations for the ACL which is now a frequently performed surgery. Brewer ace Yovani Gallardo tore his ACL in May 2008 (against the Cubs avoiding contact with Prince Fielder on a Reed Johnson bunt) and was able to come back to pitch in late September and started a playoff game vs the Phillies that season. The injured PCL has better blood supply than the ACL and therefore can heal without subsequent instability. The PCL is much less frequently reconstructed (than the ACL) and often has several other associated injuries including the ACL and meniscal tears making any associated instability more extensive, so the results are more difficult to assess and should not be compared to the more common anterior cruciate ligament reconstruction outcomes. I don't know of any major league players that have needed PCL reconstruction although I would be interested to hear if any mlb player has had this done.
I wonder if Doc Gryzlo will recommend a few games of rehab in the PCL for Barney's PCL once the swelling and soreness improves.
In a year or two, a lot of fans are going to point at trading him as a mistake. He'll probably be slashing something like 280/400/480 for Seattle at the time. Of course, by WAR, he'll still be worth less than 3, since we're talking zero defensive value.
vogelbomb debut for tacoma (AAA SEA)... 3-3, 1bb, 1 HR, 1 double...DH'd.
while he mostly played 1st considerably more than DH for AAA CHC, DJ Peterson is probably going to see most of the time at 1st for AAA SEA.
Carl Jr.! Very nice!
Baez with another "WTF?" play trying a delayed steal with a runner on 3rd and one out.. Remarkable talent, needs to make better decisions.
m.montgomery up in the pen with a man on 2nd, 2 out, and rondon 20 pitches into the inning.
...and rondon ends it 22 pitches in with a popout to RF.
I gotta say with the crappy defense the Brewers have displayed outside of Fowler I'm pretty disappointed the offense hasn't shown more and Rizzo seems to be very swing happy lately. That said my god am I happy Madden has finally given Carl Edwards a chance after multiple times up with nothing. I don't think he could handle a starting role with his body frame but his stuff plays so well in a relief role and he seems to be able to handle high stress situations very well.
2nd at bat. Fowler is good for the Cubs run differential.
welcome back fowler.
More slow news...
Did Davey Martinez have to bring the shotgun?
glad to see almora going to AAA to get work.
.265/.291/.422 through 86PA...2hr, 7 doubles.
i don't expect too much of an improvement when he's taking over CF next year, but the team doesn't really need him right now as much as they need him to get regular work (imo).
CHITOWNMVP01: The Cubs MLB Reserve List (40-man roster) has had one slot open since 7/6 (when RHRP Joel Peralta was Designated for Assignment).
The problem with the September roster is all of the pitching changes. They should find a way to limit pitchers to twelve except for extra inning games. More pinch hitters or pinch runners do little to slow the game down and are more fun than endless calls to the bullpen. I also think the fans get cheated when they use position players to pitch because employed a half dozen pitchers with righty-lefty switches. Having as few as four positions players on the bench to start a game also leads to some pretty ugly defensive substitutions.
CHITOWNMVP01: Joe Nathan's 30-day Article XIX-C minor league rehab assignment expires tomorrow, but he doesn't have to be reinstated from the 60-day DL tomorrow.
Also, I think 40 man roster should be full, not at 39, unless I counted wrong. I'm in a hurry to leave the house.
Dexter Fowler is back! "You go, we go!"
He's being activated for tonight's game. Almora down and Montgomery replaces Patton.
Also, doesn't Nathan have to be activated tomorrow? Pitchers aren't allowed to spend more than 30 days of rehab and he was sent to rehab assignment on June 23rd. Tomorrow is July 23rd.
Yeah, last night was a bummer. I clicked on the espn Gamecast just in time to see the 5-2 score change to 5-5.
Their next 10 are Dodgers, Mets and Marlins.