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.
14 in attendance. What's the record for attendance in the fall? I guess I should ask what the record attendance listed is in one of your recaps.
I was there too, with my grown son. This is my miracle year-- I rose to the top of the season ticket list after eight years, completely unexpectedly, and my wonderful wife agreed to put the ticket fee on the emergency credit card. The whole point of course was that the Cubs were going to be good this year, and then for a while, so to get season tickets with the guaranteed shot at the postseason was incredible timing. We got to the remote lot at 4:10 after stopping at Nhu Lan for our usual banh mi sandwiches, only to find the lot full, way earlier than normal.
Wrigley was electric tonite
Not many card fans
Video board was great, they played "there goes my hero" by foos over ryno highlights before he came out. Spectacular
Good times hopefully they win tomorrow but think Lester will beat poopy pants on Wednesday.
Happy 4th anniversary of Theo's signing
Go Cubs !
Yeah. "Goodbye!" is a lame HR call.
I miss Len and JD -- although, driving home from a friend's, WBBM played all 6 HR calls in a row -- and Len got to call the Bryant/Rizzo back-to-back. Very fun.
Lackey has been a beast against us. His stats on 3 days rest, however, not as nice. There is plenty of hope.
And, no dreadlocks grown yet.
Captain Obvious Strikes Again!!!
In the wild card game he mentioned that aram started with the Pirates, then played for the Brewers, and now he's back with the Pirates. Uhhhh, missed a step there, guy.
i like ron darling the person, the interview, and the studio desk guy...but him calling a game can lead to some really stupid stuff coming out of his mouth.
If you think these announcers are bad ,the ones doing the Mets vs Dodgers (Ron Darling ,Cal Ripken and someone else)
are worse they did the wildcard game I never knew Joe Jackson and Derrick Fowler played for the Cubs this year you
would think there would be research by them.
Soler's OPS in the NLDS? 3.750.
...and HRs are good.
Theo: "So, let's see...should we put Soler on the post-season roster? Ummmm, yeah, I mean what the hell."
Wow -- if he can bring that focus and plate discipline next year -- yowza! Seems like Manny has really helped him.
1st team hit hit 6HR in a game in the postseason. woo.