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.
Very bizarre game -- as you say, both Cubs pitchers were dominant until the one fatal pitch. It was like watching the Bears defense shut down a team, and then lose on 2 punt returns. Some better hitting with RISP would be a good idea, too.
Trouble Boys, the Replacements bio, is a great option. I'm sure Chad loved it.
Amen Brick. What's the point of following early-season games if you can't over-react to them? What, we should be reading books now?
"Weren't the National considered a near lock last year?"
No, I think you're thinking of Radiohead, The 1975, or Bowie's last album.
Although The National's Greatful Dead tribute is pretty cool.
I don't think they're any kind of lock, though I do expect they'll make the playoffs.
It's not like I'm glad they've gone 4-8. I just don't think it's time to be all that worried -- just like I didn't think they were going to keep playing .730 ball.
vegas isn't a fan of the game because of how erratic and unpredictable it is.
SF has recently won 3 world series many thought they weren't supposed to win...BOS won a world series recently that they weren't even supposed to be in the playoffs for...favored teams with huge wins have seen 1st round exists...fun times.
I think they'll be ok too. But having watched this team since the mid-60s, I never think it's time to conclude, well, thank god the drought is over. I've seen/heard way too many people who follow the Cubs say glad we're finally going to win the Series this year. Please. Weren't the National considered a near lock last year?
Best record in baseball and largest division lead.
I'm jumping right now!
Can we please stop pointing out how ridiculous it is to panic and start panicking in earnest?
,571 winning percentage in May.
I think they're gonna be OK.
RAISIN: All I know is that Oscar de la Cruz is still shut down, and I don't know what his prognosis is, or what the plan is going forward.
Remember just two weeks ago, when "all" they had to do was play .500 ball the rest of the season and coast into the playoffs?
Well I guess if pitchers can keep working the edges of the plate to perfection it will be a long season. But that doesn't seem likely. Rizzo finally, fully, snapping out of it would help.
If I didn't believe in coincidences (or science), I would apologize to Gordon Downie--one of my favorites. Sad news about a great talent.
Hi Arizona Phil,
Has there been any news on Oscar de la Cruz' health?