Varus Stress Test Elbow - Human Anatomy

By popular demand from yesterday's post
Some Insight on Ekeler's Injury
Who am I?
By profession I am an Athletic Trainer, I have both my Bachelor's and Master's degree in sports medicine and 10 years of practice in collegiate athletics and Industrial Injury prevention.
Full Disclaimer: I am not his Doctor, so I do not fully know the extent of his exact injury, but I will shed some light on the reported injury and what to expect. (Grade 3 MCL Sprain). I will also be as objective as possible. I cant give too much fantasy advice here, as I do not know the philosophy of his medical team and what their exact plans are. My purpose is for you to make an informed decision based on what is reported about the player and the nature of the injury I am describing.
EDIT: My Source for His Reported Grade 3, I'm willing to change this if I'm shown better.
EDIT 2: There are mixed reports as the 24/7 and The atheltic are speculation. I will keep grade 3 for the sake of overpreparing rather than underpreparing y'all. All the information remains relevant for knee injuries. If he comes back sooner, great for him and you.
4 Major Ligaments of the Knee
Ligaments: Structures of the body that connect bone to bone. These are basically the tape that hold our joints together.
The major ligaments of the knee are comprised of 2 cruciate (Anterior Cruciate;ACL, Posterior Cruciate;PCL) and 2 Collateral (Medial Collateral;MCL, Lateral Collateral;LCL).
What AnterioPosterioLateral/Medial Mean
These 4 structures help keep our femur (thigh bone) in place and stable on our tibia (shin bone). Without them, our knees would be unstable and leave us open to a wide array of injuries both in the short term and in the long term.
More specifically, the MCL prevents excessive valgus force, the LCL prevents excessive varus force. These are BIG TIME when cutting and running.
Valgus/Varus Diagram
Ligament Sprains:
There are 3 grades of sprains. Not to be confused with strains. Strains are injuries to muscles and tendons, sprains are for ligaments (you sprain you ankle/knee ligaments, you strain a muscle). Although, the grades for them are very similar. (The AC joint in the shoulder has multiple grades but that's another post)
Grade 1: There is minor damage to the structure, in terms of sprains, it is usually described as "mild stretch" of the ligament. Most people on here have probably had a grade 1 ankle sprain at some point in their lives.
Grade 2: There is mild to moderate tear in the ligament. This is a fairly significant and usually takes 3-6 weeks for full recovery. Michael Thomas, CMC (I'll go over a high ankle in a future post)
Grade 3: Near or full rupture of the ligament. This usually means missing significant time. The amount of time missed depends on what can be done to fix it.
Why Blood Supply Matters
What is a very common theme amongst injury recovery time here is the amount of blood supply the structure has. The MCL has a pretty decent blood supply running to it, the ACL however, does not.
Blood is what we use to heal our bodies. It supplies nutrients and carries away debris. So no blood supply = little to no healing. So this is why Chubb is expected back this season and Barkey is not. Barkley's ACL needs to be surgically repaired so he can safely return to his level of activity, where Chubb's MCL needs time to repair itself.
What Does This Mean For Chubb?
Quite simply, he'll be back (hopefully) this season barring any setbacks or unexpected additional injury (the meniscus can sometimes be involved, but as of now it was not). The average, I stress average, healing and return time for a grade 3 MCL is 6-8 weeks. I would also expect some "easing in" in terms of workload upon return.
Please feel free to ask any clarifying questions or if you'd like to dive deeper into the science of it all. I'm trying to keep my posts in the ELI5 theme, but im more than happy to get real technical in the comments
Next Up: The High Ankle Sprain, and why this seeming small injury screws you year after year

Warning: I wound up writing a novel here, but feel free to just look at the pics. The album contains some gross pictures, including what my knee looked like immediately after the injury as well as some pics of the inside of my knee during surgery. The surgery pics are actually so abstract that they're not that gross, but in case you don't have a strong stomach you've been warned. https://imgur.com/a/G97Dd7E
The Injury
I'm a 28 year old male (27 when the injury occurred). My initial injury happened in September of 2017. I was running towards a ball flying over my head during a soccer game, and mistimed my control of the ball - rather than get my foot under it, I stepped on the ball as it was landing. My right leg was planted when I did this, and since I was sprinting full speed I slipped, causing my whole body to move except my leg. It immediately twisted and dislocated, and I'm told people heard the pop from 40-50 yards away. An ambulance was called, but the refs were afraid to move me so the game was called off while we waited. I didn't have the guts to look down at my leg (and moving even slightly was unimaginably painful so I didn't wanna try) but I knew I would be curious about what it looked like so I had my girlfriend take pictures (pics #1 and 2 in the album).
Initial Treatment
Everyone was fascinated with my knee in the emergency department. It was a university hospital, so all sorts of residents and students came by to look at it and ask questions. Most knee dislocations reduce themselves, but mine was stuck. An orthopedic surgeon with decades of experience would later take a picture of the X-ray they took while it was still dislocated because of how bad it looked. I had to wait a couple hours for the orthopedics resident on call to make his way to me and get approval from a full doctor to reduce my knee, and during this time the adrenaline wore off. I could feel my bones pushing into the skin (I came very close to having an open dislocation, which results in amputation about 50% of the time because infections are difficult to manage), and this was probably the worst pain I've felt in my life. Some of the doctors were talking about emergency surgery to reduce my knee, since it didn't look like it would respond to manual reduction. At this point, my hero arrived - the orthopedics resident came in, looked at my knee, and said we were popping it back into place right now. They shot me up with some dilaudid and four doctors did the deed: one resident grabbed my leg around the knee and held it up while the other three grabbed around my ankle and twisted. When I say twisted, I mean three adults pulling as hard as they could. Four incredible pops later, my knee was back in alignment and the pain was immediately resolved.
They kept me in the hospital for two days for observation because they were concerned my popliteal artery might have been damaged (see Zach Miller's recent knee dislocation for what happens, emergency surgery is needed to save the leg). The artery was fine, so eventually they released me. They took MRIs while I was in the hospital, and based on the MRI and X-ray reports it initially looked like the following were torn: ACL, PCL, MCL, LCL, lateral and medial menisci, patellar tendon, knee capsule, and quadriceps, with avulsion fractures in the tibia and femur. It later turned out there was so much blood in my knee that some of the structures (mainly my menisci and LCL) looked damaged in the MRI but were actually fine. My patellar tendon was only partially torn. Everything else was completely torn (MCL off the bone, ACL and PCL in the middle), including my quad having been basically sliced by my kneecap.
I saw my sports medicine surgeon about a week after the injury (picture #3 in the album, the bruising actually got much worse after this and about 3/4 of my leg was purple) and he did the manual tests - Lachman, drawer, valgus, and varus. My ACL and PCL were definitely torn, and in the valgus test my knee was giving way like it was made of rubber. The varus test looked surprisingly stable though. I was scheduled for surgery just a few days later, and they would basically figure out how much they could do in that surgery (and whether my LCL and menisci were still in good shape) after cutting me open.
Surgery 1
The first surgery was in the end of September. There was so much edema, blood, and swelling that they were only able to repair my MCL, reattaching the original ligament to the bone. My LCL and menisci were confirmed to be healthy though, and they stitched my knee capsule and quad back together. My doctor showed me a picture (unfortunately I don't have a copy) immediately after the procedure of what the inside of my knee looked like - he described it as looking like a grenade had gone off inside my knee, and that the giant hole was not something they had done, but what my knee already looked like when they went in to look. A femoral nerve block meant that I felt absolutely no pain post-op, and I stopped taking my prescribed painkillers at the same time the nerve block wore off. The surgery also immediately cleared up a four day calf cramp I had been experiencing, which my surgeon theorized was being caused by blood flowing from the knee down my leg.
A week after, I saw my surgeon again (pic #4). The swelling had decreased significantly and I was cleared to start PT, but I was non-weight bearing for the first 4-6 weeks post-op. Surgeon wanted me to get to 120 degrees of flexion before he would operate on the ACL and PCL to avoid permanent stiffness - he seemed to think I'd get that back in about a month or so. My physical therapist was awesome, but flexion came very slowly. I was walking without crutches around December, but it wound up taking until January 2018 for me to hit 115 degrees, which my surgeon deemed good enough.
Surgery 2
Surgery #2 was in February 2018. I had been having back of knee pain so they looked at my lateral meniscus again just to verify, but it turned out to be healthy - the pain was probably just a hamstring strain. I received single bundle allografts (hamstring tissue) for both my ACL and PCL, affixed using a button rather than screw (as I understand it, the screw is more beneficial when using patellar grafts that include some bone, but for hamstring grafts the button allows the grafts to be tighter). Autografts were not an option since my knee was so damaged that the doctor didn't feel comfortable harvesting anything else. The nerve block this time was botched so it was only partially effective, but even then pain post-op was minimal. The images labeled 001-009 are of the surgery itself: 001-003 are my medial and lateral meniscus looking good, 004-005 are the drill creating the tunnel in my bones for the grafts, 006-008 are the new ACL and PCL grafts, and 009 is of where my kneecap meets the rest of my knee. After the surgery, I was told that my knee injury was part of an annual presentation by the residents at the university - a dubious honor, but pretty cool.
I was allowed to partially weight bear immediately this time, but I had some weird lumpy swelling (see pic #5) that felt pretty uncomfortable when I would put weight on the leg. I was also put on a CPM machine immediately after the surgery, and hit around 85 degrees of flexion (120 on the CPM, but it does not reflect real flexion very well) within a week. After a PCL reconstruction, however, you're not allowed to bend your own knee for the first four weeks - when the hamstring activates during flexion and pulls back the tibia, it puts stress on the PCL graft which can cause it to loosen. I was on strictly PT-assisted or CPM flexion for the first month, and after that I was given a custom-fit PCL brace made by Ossur that applied a force at my tibia during flexion to counteract the stress on the graft.
The hamstring strain actually got a lot worse during this period, and started to hurt incredibly while doing heel slides. Between lots of hamstring stretching and slowly working on heel slides, however, it eventually faded. The swelling went down, flexion improved, and I was told to drop the crutches as soon as my PCL brace arrived.
Present Day
I had my three month followup earlier this week, and my doctor said all of the repaired/reconstructed ligaments felt incredibly stable. I was expecting to be on the PCL brace for 6 months, but got the all-clear to drop the brace immediately. I was so happy to be done with the brace (which was the 5th knee brace I had gotten for this injury) that I went out and tried riding a real bike for the first time - I was a little shaky, but eventually I got comfortable riding. Stationary bikes are nice, but I had been so excited to finally feel the wind on my face while riding.
I'm not sure that I'll ever actually want to play soccer again, but my goal for PT is to recover to the point that I could play if I felt like it. Not there yet, but I'm told in 6 weeks I might be able to start jogging. Slow progress, but any progress is awesome considering 6 months ago it felt like I would never be close to normal again. Thanks for reading, and feel free to ask any questions!