Knee Orthopaedics Rehab Protocols We're glad you're enjoying ignitephysio! It is critical that the hinged knee brace has enough rigidity to stabilise medial and lateral movement. Medial collateral ligament Injury of the knee (MCL Tear) are the most common ligament injuries of the knee and are frequently associated with ACL tears. Grade III: >10 mm of opening.   The knee can be immobilized for a few days initially, but early range-of-motion will help in the recovery process. The rehabilitation protocols for grade I and II injuries are similar (except for the length of time for the patient to progress through the various stages). may be needed, … Acute stage, subacute stage and late stage sports specific rehabilitation. Grade III MCL Tears. There are types of MCL injuries that may require further intervention, especially if other structures are involved. The ACL attaches from the front part of the tibia to the back part of the femur. A grade 3 tear usually takes four to eight weeks to heal, unless the ACL is also damaged, in which case recovery may take longer. Patient will wear immobilizer for 2 weeks following injury, except in P.T. Rehabilitation and treatment protocols for hamstring injuries: Acute phase: (1 to 5 days) Initial management of RICE protocol ( Rest, Ice, Compression and Elevation ) … Treatment of ACL & MCL Injuries: ACL & Grade 1 MCL: Minor injuries are treated with rest and anti-inflammatory medications with immediate range of motion and gait retraining exercises aiming to achieve a pain free mobile joint prior to re-evaluation to assess laxity. Improve strength and stability with a gradual return to normal training. The aims of lateral ligament injury rehabilitation are: To reduce pain and swelling. The majority of people recover using nonsurgical treatments. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals. Braced set to between 30- 60 degrees flexion for 7 days (Phase 2) #3. Posterior knee pain may mean the patient is progressing too qulckly Guidelines: Must be highly individualized. Injuring two or more of the four major knee ligaments is uncommon and usually Knee injuries that involve one of the four ligaments are somewhat common. Medial Collateral Ligament Sprain: Rehab Exercises. ACL Non-Operative Protocol . The surgery will either repair or reconstruct the MCL. Nonsurgical Treatment Options for MCL Tears or Sprains More severe trauma requires different treatment options and a longer rehabilitation period. 2017 England’s Alex Hales is down after sustaining an injury to his knee Action Images via Reuters/Andrew Boyers . Grade 3 injury : Complete rupture which has to be surgically repaired and rehabilitation to follow for approximately 3 months. Ease off the exercises if you start to have pain. Gentle ROM's. Unlike the dreaded ACL tear, MCL injuries respond really well to non-surgical treatment plans. Cost for MCL Injury Surgery. Rx. But let’s assume we are dealing with an isolated Grade 3 MCL injury. The main emphasis focuses on: 1. Athletes with a grade II injury can return to activity once they are not having pain over the MCL. My bracing plan would look like this: #1. Treatment is usually bracing unless there is gross varus instability in which case repair or reconstruction is performed. An injury of the medial compartment occurs when a valgus force is applied to the knee, with a contact or non-contact mechanism. To get access to all of our great features and content, sign-up today for a free account. Grade 1 MCL injuries almost always heal, while Grade 3 MCL injuries mostly heal. Start each exercise slowly. Grade 3 Tear – 8-12 Weeks . Grade III tears may have an immobilization period prior to onset of rehabilitation, per provider order. Patients with a grade II injury often return to sports within three to four weeks after their injury. Grade 1: Mild MCL Injury. a. degrees of flexion.2 Opening of 0-5 mm indicates a Grade I tear, 6-10 mm a Grade II tear and more than 10 mm a Grade III tear.1 Anterior cruciate ligament (ACL) injuries occur with up to 78% of Grade III MCL tears.3 The amount of laxity in each position of flexion is indicative of the number of medial structures injured. Grade 2 and 3 injuries locked in extension x 10-14 days prior to initiating physical therapy and then limited 0-90 degrees for an additional 2 weeks. If the ACL laxity persists after the MCL has healed, ACL reconstructive surgery should proceed. The exercises may be suggested for a condition or for rehabilitation. Introduction. It means that your ligament has been stretched but not torn. For a grade III medial knee injury combined with another injury, for example, an ACL tear, the general protocol is the rehabilitation of the medial knee injury first so it can allow healing according to the guidelines for an isolated medial knee injury. Reducing inflammation 2. MCL sprain rehab protocol for a grade 1, 2 and 3 medial knee ligament sprain. Introduction. If greater than 900 of knee flexion is performed, this MUST be done with an anterior drawer force to prevent posterior subluxatlon. ACTIVITIES AND EXERCISES AFTER INJURY TO THE MEDIAL COLLATERAL LIGAMENT (MCL) OF THE KNEE. The ability to drive after an MCL injury depends on the grade of injury as well as how the knee has responded to the exercises. Acute treatment. If there is any increase in pain or swelling or loss of ROM, these can serve as signs that the progression of the patient may be too rapid. GRADE I, II, III ISOLATED MCL SPRAIN PROTOCOL NOTE: The above program may be accelerated for first degree MCL sprains or may be extended depending on the severity of the injury. A good rehab program is needed but you should be back drilling in 4 weeks. of modalities for pain and swelling as needed. A grade 1 ligament sprain is a minimal injury with little to no increase in laxity to the ligament whereas a grade 3 sprain is a complete rupture to the ligament. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). Restore full mobility to the knee. When a grade II MCL tear occurs, use of a hinged knee brace is common in early in early treatment. Both nonsurgical and surgical treatment options may be used to treat injuries to the knee’s medial collateral ligament (MCL). It is not meant as a home program. Generally speaking, return to competition is allowed once the patient is: pain-free with full range of motion, has no instability; and has muscle strength comparable with the uninjured side. You may also need surgery if you have other combined knee complications. Ask your burning questions. How to do the exercises. Surgical Methods. Medial Collateral Ligament (MCL) Rehabilitation Protocol Weeks post-injury 1-2 Weeks Initiate physical therapy. When a grade III MCL tear occurs, patients should brace their knee and use crutches until the pain has subsided. Here are some examples of exercises for you to try. Get Answers. Protocol for bracing after grade 3 MCL sprain (with ACL injury) Jan. 7, 2017. MCL injuries can be grades 1, 2, or 3: A grade 1 MCL injury is the least severe. A grade 2 MCL injury … Crutches and restricted weight bearing may be needed, as … Injuries to the medial collateral ligament most often happen when the knee is hit directly on its outer side. 1 In some cases, such as severe tears in elite athletes or people with multiple knee ligaments injuries, surgery may be recommended. You will be told when to start these exercises and which ones will work best for you. MEDIAL COLLATERAL LIGAMENT (MCL) RECONSTRUCTION/ REPAIR POST-OP REHABILITATION PROTOCOL The following is a protocol for postoperative patients following ACL reconstruction. Please note this protocol is … PHASE 1: THE FIRST SIX WEEKS AFTER INJURY (grade 2 and 3) THREE WEEKS AFTER INJURY (grade 1) The knee should be to be protected with a hinged brace for 3 to 6 weeks, depending upon the severity of the injury. Ohio State physicians and physical therapists work collaboratively to develop best clinical practices for post-surgical rehabilitation. The good news, however, is that absent another type of injury occurring at the same time in the knee, an MCL injury in lacrosse players rarely requires surgery. MEDIAL COLLATERAL LIGAMENT (MCL) OF THE KNEE. The below schedules are just guidelines. Grade 2 tear: a significant number of fibres are torn with moderate loss of function. It is designed for rehabilitation following a PCL injury/tear, typically grade I and II. Sports Medicine Rehabilitation Protocols. A MCL tear can be graded as follows: Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function. Orthopaedists grade MCL injuries in terms of their severity, treatment protocol, and recovery time. Anatomy and Biomechanics The knee is a hinge joint connecting the femur and tibia bones. The following schedule serves as guidelines to help in the expediency of returning a patient to his or her pre-injury state. Grade III MCL injuries should be immobilised using a hinged knee brace with the knee at 30 degrees flexion to minimise the distance between the two ends of the torn ligament. Ask Your Questions. Braced locked at 30 degrees for 7 days (Phase 1) #2. Grade 3 tear: all fibres are ruptured resulting in elbow instability and major loss of function. MCL Sprain Non-Operative Protocol Information: The following is Dr. Lind’s non-operative protocol. Below are examples of lateral ligament rehab programs for grade 1, grade 2 and grade 3 ligament injuries: Multiligament Knee Injury (ACL/PCL +/- MCL/PLC) Rehabilitation following surgery for multiligament knee injury (MLKI) or knee dislocation is an essential element of the treatment to achieve a full recovery. If MCL Injury Requires Surgery: Generally, surgery is not required for an MCL injury unless it is a Grade 3 injury or does not heal with home care and therapy. Restoring full range of motion 3. the severity of the injury. The medial collateral ligament's main function is to prevent the leg from extending too far inward, but it also helps keep the knee stable and allows it to rotate. In this follow-up article, Chris discusses the typical rehabilitation protocol following MCL injury and provides examples of rehab exercises. The medial collateral ligament usually responds well to nonsurgical treatment. Protocol for Non-Operative Treatment of PCL Tears Precautions: Avoid greater than 900 of knee flexion for the first 6 weeks po st injury. No valgus stress or open chain for 6 wks. Ice the knee to help with pain and swelling. Treatment of Grade III MCL Tears . Crutches and restricted weight bearing . Grade 2 injury : Grade 2 injury requires a minimum period of 4 to 8 weeks for recovery. ACTIVITIES AND EXERCISES AFTER INJURY TO THE . Initially, all suspected knee sprains should be treated with the RICE protocol: rest, ice, compression of the knee with an elastic bandage, and elevation of the leg.