collateral lig injuries

8/7/2019 Collateral Lig Injuries

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CONTACT NONCONTACT

OVERUSE


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VALGUS STRESS TESTING

AT O DEGREE OF KNEE

FLEXION


AT 3O DEGREE OF KNEE

FLEXION


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SLOCUMS TEST FOR ANTEROMEDIAL ROTATORY

INSTABILITY


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CLASSIFICATION SYSTEMS

AMERICAN MEDICAL ASSOCIATION COMMITTEE ON MEDICAL ASPECTSOF SPORTS

Grade 1 - 0-5 mm of opening

Grade 2 - 5-10 mm of opening

Grade 3 - Greaterthan 10 mm of opening

O'DONOGHUES CLASSIFICATION

Grade 1 - Fewtorn fibers,structurallyintact

Grade 2 - Incompletetear,no pathologiclaxity

Grade 3 - Completetear, pathologiclaxity


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GRADING OF MCL INJURIES BY USING


Grade I: 1-4 mm Grade II: 5-9 mm Grade III: 9-14 mm


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FUNCTIONAL ASSESMENT :

SINGLE HOP TIMED HOPTRIPLE HOP

FOR

DISTANCE

CROSSOVER

HOP FOR

DISTANCE


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30 METRE AGILITY TEST :

START

FINISH


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Inanormal MRI,medialcollateral

ligamentasathin,taut,well-defined,

low-signalstructureextending from

the medial femoralepicondyleto the

medialtibial metaphysis

Grade I medialcollateral

ligamenttearwithedema &

normalthickness

Continuedcloseappositionto the

femoralandtibialcortices.


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Grade II medialcollateralligament

tear

Slightthickening ofthe medial

collateralligamentandseparation

from theunderlyingcortices

Acutegrade III tearwitha folded

ligament (arrow)andsurroundingedema


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MRI SHOWING MEDIAL COLLATERAL

LIGAMENT INJURY


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ASSOCIATED INJURIESASSOCIATED INJURIES

Calcification ofthe proximalportion ofthe medial

collateralligament (arrow)

consistentwithachronic

medialcollateralligamenttear

(Pellegrini-Stiedadisease.)

Avulsions ofthe fibular

head (seenbelow) or of

thelateraltibial

metaphysis maybeseen

withinjuries ofthe LCL


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CONSERVATIVE MANAGEMENT

Treatment Protocol for Non operativeGrade I or II MCL Sprains

I. MAXIMAL PROTECTION PHASE

Goals: Early protected ROM

Prevent quadriceps atrophy

Decrease effusion/pain

A. Time of Injury: Day 1

Ice, compression, elevation

Hinged knee brace, nonpainful ROM; if needed

Crutches, weight bearing as tolerated Passive ROM/active-assistive ROM to maintain mobility

Electrical muscle stimulation to quads (8 hours a day)

Isometric quadriceps exercises: quadriceps sets, straight-leg raises

(flexion)


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B. Day 2

Continue above exercises

Quadriceps sets Straight-leg raises (flexion,

abduction)

Hamstring isometric sets

Well-leg exercises

Whirlpool for ROM (cold forfirst 3-4 days,

then warm)

High-voltage galvanic

stimulation to control swelling

C. Days 3-7

Continue above exercises

Crutches, weight bearing

as tolerated

ROM as tolerated

Eccentric quadriceps work

Bicycle for ROM stimulus

Resisted knee extensionwith electrical muscle

stimulation

Initiate hip adduction and

extension

Initiate mini-squats

Initiate leg-press isotonics

Brace worn at night, brace

during day as needed


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II. MODERATE PROTECTION

PHASE

Criteria for Progression:

1. No increase in instability2. No increase in swelling

3. Minimal tenderness

4. Passive ROM 10-100 degrees

Goals: Full painless ROM

Restore strength

Ambulation without crutches

A. Week 2

Continue strengthening

program with progressiveresistive exercise (PRE)

Continue electric muscle

stimulation to quads during

isotonic strengthening

Continue ROM exercise

Emphasize closed kinetic chain

exercises; lunges, squats, lateral

lunges, wall squats, lateral step-

ups

Bicycle for endurance

Water exercises, running in

water forward andbackward

Full ROM exercises

Flexibility exercises, hamstrings,

quadriceps, iliotibial band, etc.

Proprioception training (balance

drills)

Stair Master endurance work


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B. Days 11-14

Continue all exercises in week 2

PREs emphasis on quadriceps, medial hamstrings,

hip abduction

Initiate isokinetics, sub maximal maximal fast contractile

velocities

Begin running program if full painless extension and flexion are

present

III. MINIMAL PROTECTION PHASE

Criteria for Progression:

1. No instability

2. No swelling or tenderness

3. Full painless ROM

Goals: Increase strength and power


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A. Week 3

Continue strengthening

program

Wall squats

Vertical squats

Lunges

Lateral lunges

Step-ups Leg press

Knee extension

Hip abduction and

adduction

Hamstring curls

Emphasis:

Functional exercise drills

Fast speed isokinetics

Eccentric quadriceps

Isotonic hip adduction,

medial hamstrings

Isokinetic test

Proprioception training Endurance exercise

Stationary bike 30-40

minutes

NordicTrac, swimming, etc.

Initiate agility program,

sport-specific activities


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IV. MAINTENANCE PROGRAM

Criteria for return to competition:

1. Full ROM2. No instability

3. Muscle strength 85% of contralateral side

4. Proprioception ability satisfactory

5. No tenderness over MCL

6. No effusion7. Quadriceps strength; torque/body weight ratios

8. Lateral knee brace (if necessary)

Maintenance Program

Continue isotonic strengthening exercises

Continue fl exibility exercises

Continue proprioceptive activities


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RUSSIAN STIMULATION IN CKCCRYO-COMPRESSION UNIT

LATERAL STEP UPS

USING THERABANDS


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SINGLE LIMB STANCE Frontal plane motioninerect trunkposture.

Sagittal plane motioninerecttrunkposture Trans plane motioninerecttrunkposture.


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Sagittal plane motioninextendedtrunkposture

Transverse plane motioninextendedtrunkposture.

Frontal plane motioninextended

trunkposture.Sagittal plane motionin flexed

trunkposture.


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Transverse plane motion inflexed trunk posture.

Frontal plane motionin flexedtrunk

posture.


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Management: Return to play indicationsFunctional Tests suggesting return to play

One legged hopping

Skipping rope Trampoline jumping

Balance board (wobble board)

Stair climbing

Grade 1 to 2 MCL SprainAnticipate return to play at 4-6 weeks after injury

Return to forward Running at 60% of knee strength

Return to sprinting at 80% of knee strength

Return to contact at 90% of knee isokinetic strength


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Grade 3 MCL Sprain

Anticipate return to play at 8-12 weeks after

injury

Criteria for return to play

Isokinetic strength at 80%

Adequate performance while sprinting

Valgus stress tolerated without medial Knee

Pain


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collateral lig injuries

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