10 Medial Knee Grade 2 and 3 Isolated Injuries Protocol

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10 Medial Knee Grade 2 and 3 Isolated Injuries Protocol

Medial Knee Injuries Protocol (Grade 2 and 3) Goals: Control swelling. Initiate quadriceps re-activation. Early, pain-free full range of movement. Encourage mechanotransduction (healing stimulus). Avoid re-testing valgus stress until 3-4 weeks post-injury. 1-2 weeks: § POLICE protocol. § Long lever Brace fitted 0-90°. § Crutches: TTWB → PWB → 1 crutch (opposite side) → FWB (if no limp) as able. § SQ’s (30 reps x 10 daily), SLR if no lag (if lag: perform with Brace locked at 0°). § Stationary bike ASAP (10-20 mins): increase time and resistance as tolerated. § Hip maintenance exercises: (Sitting flexion, Side-lying abduction, standing extension). § Standing hamstring curls if no pain. 3-4 weeks: § Continue with ROM ex’s and Brace. § Gently re-assess staBility to check healing (valgus laxity at 20° and 0° knee flexion). § Start weighted exercises (knee ext, hamstring curls, leg press) Between 0- 90° in Brace. § Stationary Bike for 20 minutes: increase resistance as tolerated. § Step ups 5 weeks: § Re-assess staBility to confirm healing (i.e. no valgus laxity at 20° and 0° knee flexion). § Aim for full symmetrical ROM. § Open Brace fully as per quadriceps control on weights machine. § Progress walk to run as tolerated in brace. § Start proprioceptive and balance work once knee staBilised clinically. 6 weeks + § Remove Brace for walking if normal gait: use Brace outdoors as required. § Continue exercise Bike until 12 weeks (at least 20 minutes per day). § Progress sports specific exercises. § For grade 3 injuries wear Brace for competition for at least 3 months post-injury. § Return to competition if FROM, full strength and >85% of good leg on functional tests (e.g. hop for distance, hop for time, timed cross over hop). 8 weeks + § If knee remains unstaBle refer to orthopaedics with covering letter. References LaPrade, R.F., Wijdicks, C. A. (2012) The Management of Injuries to the Medial Side of the Knee, Journal of Orthopaedic & Sports Physical Therapy. Vol: 42 (3), pp 221-233. Written By: Mr Richard Norris, Orthopaedic Physiotherapy Specialist Ratified By: Professor MJ McNicholas, Consultant Orthopaedic Surgeon Date last reviewed: DecemBer 2015 .

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Medial Collateral Ligament Injury of the Knee: a Review on Current Concept and Management
)255( COPYRIGHT 2021 © BY THE ARCHIVES OF BONE AND JOINT SURGERY CURRENT CONCEPTS REVIEW Medial Collateral Ligament Injury of the Knee: A Review on Current Concept and Management Farzad Vosoughi, MD1; Reza Rezaei Dogahe, MD1; Abbas Nuri, MD1; Mohammad Ayati Firoozabadi, MD1; S.M. Javad Mortazavi, MD1,2 Research performed at the Joint Reconstruction Research Center (JRRC) of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Received: 10 May 2020 Accepted: 04 March 2021 Abstract The medial collateral ligament (MCL) is a major stabilizer of the knee joint, providing support against rotatory and valgus forces; moreover, it is the most common ligament injured during knee trauma. The MCL injury results in valgus instability of the knee and makes the patient susceptible to degenerative knee osteoarthritis. Although it has been nearly a dogma to manage MCL injury nonoperatively, recent literature has suggested operative MCL management as a suitable option for specific patient populations. The present review aimed to assess the current literature on the management of MCL injuries of the knee. In this regard, we go over the anatomy, physical examination, and MCL imaging. Level of evidence: IV Keywords: MCL, MCL reconstruction, MCL repair, POL, PMC Introduction he medial collateral ligament (MCL) is the most may be indicated in certain instances (5). In this review, common knee ligament to be injured during we discuss this concept with the aim of delineating the Tknee trauma (1). The annual incidence of MCL management principles of the MCL injury. injury has been reported as 0.24-7.3 per 1,000 people with a male to female ratio of 2:1 (1, 2).
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