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.

Comments

The Phillies "are making inquiries on established and pricey veterans" as they search for a right-handed hitting outfielder, reports ESPN's Buster Olney.

Right-handed and pricey...do we have anyone that meets that criteria? Take them we want nothing in return!

Marmol and Soriano, we can do this!

I'd throw in Darwin Barney, Josh Vitters and DJ LeMath to sweeten the deal.

and Hendry. :)

Plus Quade and Crane kenney!!!

p.s. - nice header...

Castro with 2 walks already. Prepare for the apocalypse.

Fukudome home run sighting!

The new TCR meme? "Prepare for the apocalypse."?

As in... Fukudome hit a home run, prepare for the apocalypse. Or... Soriano just exerted some effort, prepare for the apocalypse.

fukudome a 2b away from completing the tour de wrigley?

The Brewers really need to fire the guy who told Rickie Weeks he could run all day on Fukey's arm.

Same old Meat Tray

speaking of same ol...

"Astros released 1B Brian Dopirak."

They also released Max Ramirez.

JoseCanseco Jose Canseco
Love my Yuma Scorpions offense and with improved bullpen we can win this league

JoseCanseco Jose Canseco
OUr new centerfelder Joey Gathright is electric and reminds me of rickey

JoseCanseco Jose Canseco
Lake house has no chandeleers and I need some. Any light company want to trade 2 or 3 for signed bat or any game worn piece of equipment.

...not a joke, real tweet. lulz...canseco.

also, not a joke, but kinda a joke...

OzzieCanseco Ozzie Canseco
We need to decorate with something other than 900 copies of Juiced. RT @iRespectHorses What's the deal with @JoseCanseco and chandeliers lol

http://twitter.com/#!/JoseCanseco

someone drug test this guy...actually, just let him OD. rod beck dies, this guy lives...sigh.

Enjoy Yuma Shakey

as much as i love arizona, i think enjoying yuma is near impossible...especially now through september...

farm fields, angry citizens, a military base, and non-stop sun and wind.

See Road Warrior

Favorite sight in Yuma...RV's camping out in the middle of cloverleaf on and off ramps.

i think i'd rather see a movie featuring the other billy beane.

i like how all the A's scouts are elderly as hell and paul d's character isn't paul d...and he seems to have gained 100 lbs.

it's not a documentary or a reenactment, it's a fictional dramatization that they're trying to find a mass audience for...

yes, i realize it...i'm just picking on it's heavy-handedness because i'm familiar with the game of baseball, the book, and some of the people involved...as most of us here are.

they're setting up scenes with very black/white contrasts in character.

the hatteberg thing i mentioned yesterday, the ancient old out of touch scouts vs. billy beane, etc etc.

You mean jack and Kate were not on the titanic?

i've only seen 2 clips/previews, but so far it paints the oakland scouts as out-of-step elderly guys and scott hatteberg is a guy who's dumbfounded by the extremely odd and unheard-of move of having a catcher become a 1st baseman.

there's black and white and there's grey...i like a little more grey when setting up characters...humanity, not a comic book.

That was my problem with "A History of Violence". Nice premise, comic book execution (shouldn't be a surprise, as it was based on a comic book).

87% on Rotten Tomatoes - if Moneball (whose trailer is running in front of Green Latern) is that good, no one will complain.

Having watched the trailer, it doesn't look very good. I'll watch it, regardless.

The lead character in The Blind Side book wasn't the mom... it's Hollywood.

as much as i love arizona, i think enjoying yuma is near impossible...
---
And that damn 3:10 train

+1

Great re make

Boy, and I thought I had a hard time getting to the train in the morning.

Speaking of random topics......How was Russ Canzler not good enough over the legendary Brad Snyder after last season? I'm not saying to start at 3B or anything like that....but as a bench guy? he put up decent #'s at AA last year...and in AAA this season is hitting .298/.410/.498 with 8HR and 19 doubles in 250 PA's

Submitted by Dusty Baylor on Fri, 06/17/2011 - 9:15am.
Speaking of random topics......How was Russ Canzler not good enough over the legendary Brad Snyder after last season? I'm not saying to start at 3B or anything like that....but as a bench guy? he put up decent #'s at AA last year...and in AAA this season is hitting .298/.410/.498 with 8HR and 19 doubles in 250 PA's

----------------------------------

DUSTY B: Russ Canzler was a Rule 55 minor league free-agent (6YFA) after last season, and since he had yet to play above AA in seven seasons with the Cubs, he probably decided it might be in his best interests to try his luck with another organization.

Generally the Cubs invite all of their minor league free-agents to return for another season, leaving it up to the player whether to return or not. Obviously Canzler decided to look elsewhere.

Besides Canzler moving over to Tampa Bay, Mitch Atkins signed a minor league contract with Baltimore, Jeff Gray signed a minor league deal with the White Sox, and Scott McLain and Jeff Reed retired, but otherwise everybody else came back for 2012 (with Mark Johnson returning not as a player but as the Boise manager, and Jason Dubois sticking around as the AZL Cubs hitting coach).

BTW, after a long career as a slugging 3B in AAA and in Japan, Scott McLain is now the U. S. Scout for the Hiroshima Carp.

Canzler wasn't aggressive enough at the plate. Generally the Cubs don't like players with more than a 30 point differential between batting average and On Base.

Lmao......nice!!

All I know about his defense is the .866 FP at third, but let's stipulate that he didn't project as a major-league 3B. That leaves 1B/LF/DH. Righty hitters like that don't find employment in the majors.

The problem was never his hitting, it was the other half of his game. (That's how you know he was pre-Wilken.)

Meh.....for a bench guy...if he can hit....eh.

That explains Vitters....

oh wait

No, that's true, Vitters is an anomaly among Wilken picks. But at the top of the draft, you're supposed to be able to get a Ryan Braun (another alleged third baseman and a fifth pick), an elite hitter whose bat trumps his glove.

Typically the best high school bat in a draft is "an elite hitter". Also there was at the time and still is more of a feeling that Vitters can play third at the MLB level than Braun could.

If you could take Aramis Ramirez, you won't mind Vitters' defense.

Since you mention it, I've always thought that good teams have third basemen with better gloves than Aramis--like the Cards, who moved Pujols to first and traded Brett Wallace.

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