who is this?. what happened? how much rain? medial collateral ligament
TRANSCRIPT
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Who is this?
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What Happened?
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How much rain?
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Medial Collateral Ligament
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MCL• The medial collateral ligament
(MCL) is one of four ligaments that are critical to the stability of the knee joint.
• A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility.
• The MCL resists widening of the inside of the joint, or prevents "opening-up" of the knee.
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One of the most common knee ligaments injuries in sports
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Anatomy -Three layers
• Superficial MCL – primary static stabilizer (under the satorial fascia) – valgus and ER
• Deep MCL – middle third of medial capsule
• Posterior Oblique Ligament – 3 attachments functions with semimembranosus
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Dynamic stabilizers of medial knee
• Semimembranous complex
• Quadriceps
• Pes anserine
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MCL Injuries
• Because the MCL resists widening of the inside of the knee joint, the ligament is usually injured when the outside of the knee joint is struck.
• This force causes the outside of the knee to buckle, and the inside to widen.
• When the MCL is stretched too far, it is susceptible to tearing and injury. • An injury to the MCL may occur as an isolated injury, or it may be part of a
complex injury to the knee.
• Other ligaments, most commonly the ACL, or the meniscus, may be torn along with a MCL injury.
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Symptoms of MCL Tears
• The most common symptom following an MCL injury is pain directly over the ligament.
• Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury.
• In more severe injuries, patients may complain that the knee feels unstable, or feel as though their knee may 'give out' or buckle.
• Symptoms of a MCL injury tend to correlate with the extent of the
injury. MCL injuries are usually graded on a scale of I to III.
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Symptoms
• 67% of patients with complete tear could walk into the office unaided
• Pain was worse with incomplete rather than complete
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X-rays
• Anteroposterior
• Lateral
• Merchant view
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Grade I MCL Tear
• This is an incomplete tear of the MCL. • The tendon is still in continuity, and the symptoms are
usually minimal.
• Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly.
• Most athletes miss 1-2 weeks of play.
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Grade II MCL Tear
• considered incomplete tears of the MCL.
• These patients may complain of instability when attempting to cut or pivot.
• The pain and swelling is more significant, and usually a period of 3-4 weeks of rest is necessary.
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Grade III MCL Tear
• A grade III injury is a complete tear of the MCL.
• Patients have significant pain and swelling, and often have difficulty bending the knee.
• Instability, or giving out, is a common finding with grade III MCL tears.
• A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
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MCL injuries
• Isolated
• Combined with other injuries
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Knee in 30 degrees of flexion compare to other knee – degree of opening and the end feel
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Surgery for MCL Tears:
• Surgery for MCL tears is controversial.
• There are many studies that document successful nonsurgical treatment in nearly all types of MCL injuries.
• patients who complain of persistent knee instability,, surgery is reasonable.
• Some surgeons advocate surgical treatment of grade III MCL tears in elite athletes or in those athletes with multiple ligament injuries in the knee
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Rehabilitation
• Early protected ROM
• Strengthening
• Laxity of knee in extension – red flag
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Treatment
• Treatment of an MCL tear depends on the severity of the injury.
• Treatment always begins with allowing the pain to subside, beginning work on mobility, followed by strengthening the knee to return to sports and activities.
• Bracing can often be useful for treatment of MCL injuries.
• Fortunately, surgery is not necessary for the majority
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Rehabilitation Protocol • MCL injuries who require an early return to high level activity
following injury.
• Goals of rehabilitation are to: Control joint pain, swelling Regain normal knee range of motionRegain a normal gait pattern Regain normal lower extremity strength Regain normal proprioception, balance, and coordination
• The physical therapy is to begin as soon as possible after the injury.
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Phase 1: Week 1-2Range of Motion:
• Passive ROM, No limits• Aggressive Patella mobility• Ankle pumps• Gastroc-soleus stretches• Wall slides• Heel slides
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Strength:
• Quad sets x 10 minutes• SLR (flex, abd, add)• Multi-hip machine (flex, abd, add)• Mini squats (0-45 °)• Multi-angle isometrics (90-60 °) (No tension on MCL)• When working adductors stress point should be superior to knee• Calf Raises
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Balance Training:
Weight shifts (side/side, fwd/bkwd)
Single leg balance
Plyotoss
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Weight Bearing:
Wt bearing as tolerated
Crutches until quad control is gained, then discontinued
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Bicycle:
May begin when 110 ° flex is reached
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Modalities:
E-stim/biofeedback as needed
Ice 15-20 minutes with knee at 0 ° ext
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Brace:
Wear brace at all times with the following exceptions:
Remove brace to perform ROM and PT activities
Immobilizer is D/C'd at 2 weeks pending physician exam
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Goals for Phase 1:
ROM
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Phase 2: Week 3Range of Motion:
Passive ROM, No limits
Aggressive Patella mobility
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Strength:
• Continue remedial strengthening as needed• Leg press• Step up, step down• Stairmaster• Leg curl• Multi-hip machine (flex, abd, add)• When working adductors stress point should be superior to knee• Calf Raises
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Weight Bearing:
Full weight bearing
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Bicycle:
Increase tension
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Balance Training:
• Balance board/2 legged• Cup walking/hesitation walk• Single leg balance• Plyotoss
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Modalities:
E-stim/biofeedback as needed
Ice 15-20 minutes with knee at 0 ° ext
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Goals for Phase 2:
ROM 0-125 °
Increase muscle strength and endurance Restore proprioception
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Brace:
Wear brace at all times with the following exceptions:
Remove brace to perform ROM and PT activities
immobilizer is D/C'd at 2 weeks pending physician exam
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Phase 3: Week 4
Range of Motion:
Passive ROM, No limits
Aggressive Patella mobility
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Strength:
• Progressive resistance exercises• Smith press• Leg press• Step up, step down• Stairmaster• Leg curl• Multi-hip machine (flex, abd, add)• When working adductors stress point should be superior to knee• Calf Raises
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Weight Bearing:
Begin jogging
Progress functional agility exercises as tolerated
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Bicycle:
Increase tension
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Balance Training:
• Balance board/2 legged• Cup walking/hesitation walk• Single leg balance• Plyotoss
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Modalities:
E-stim/biofeedback as needed
Ice 15-20 minutes with knee at 0 ° ext
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Brace:
None
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Goals for Phase 3:
• ROM Full• Increase muscle strength and endurance• Jogging• Functional Agility Exercises
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Phase 4: Week 5-6
Range of Motion:
Passive ROM, No limits
Aggressive Patella mobility
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Strength:
• Progressive resistance exercises• Smith press• Leg press• Step up, step down• Stairmaster• Leg curl• Multi-hip machine (flex, abd, add)
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Weight Bearing:
Functional agility exercises as tolerated
Progress to sprinting
Progress to sports specific agility drills
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Bicycle:
•
As needed
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Balance Training:
Steam boats in 4 planes
Single leg stance with plyotoss
Wobble board balance work-single leg
½ Foam roller work
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Modalities:
E-stim/biofeedback as needed
Ice 15-20 minutes with knee at 0 ° ext
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Goals for Phase 4:
ROM Full
Increase muscle strength and endurance
Sprinting
Sport Specific Agility Exercises
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Return to sport
• is allowed when the patient can perform sprinting and sports specific agility drills in an unrestricted manner.
• This usually occurs at the 5-6 week post-injury date