MCL Protocol PHASE 1 - ACUTE (0-4 WEEKS) PHASE GOALS: PROTECT FLEXION, RESTORE AMBULATION & ADL STATUS RANGE OF MOTION 0-1 WEEKS - FLEXION ALLOWED: 0-30 DEGREES 1-2 WEEKS - PROGRESS FLEXION TO 60 DEGREES 2-4 WEEKS - … Easy stationary bike for range of motion (ROM's), Quads, straight leg raises (SLR's), calf raises. ACL injury Posterior Cruciate Ligament Reconstruction This protocol is a guideline for your rehabilitation after posterior cruciate ligament reconstruction. The brace is locked in extension with toe-touch weight bearing during ambulation and unlocked for knee range-of-motion exercises. Harilainen et al have compared the effects of functional bracing after ACL reconstruction against not bracing post- operatively. Active Range of Motion and Early strengthening (2 – 6 weeks). Full cervical spine ROM(flex, ext, rotation, and side flexion), In supine lying: Active assisted or active elbow flexion and extension in range 30 to 100 degrees with foreman supination, Initiate elbow flexion and extension isometrics. Grade 1 Rehab: MCL rehab can begin immediately following the injury and should be focused on proper mobility and recovering full range of motion in about a 2-4 weeks window. The need for postoperative functional bracing and for consensus involving the duration of the bracing in many rehabilitation protocols comes into question. rehabilitation activities if limited by pain. Proprioception and neuromuscular control drills, Light manual resistance in PNF patterns with proximal stabilization. • MADISON, WI 53718 Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction The knee joint is comprised of an articulation of three bones: the femur (thigh bone), tibia (shin bone), and patella (knee cap). • Quad sets & SLR (Brace on) with no lag • TTWB with crutches • Ice or Cryocuff Unit on knee for 20-30 minutes every hour • Passive ROM exercises: … Rehab Protocols. UW HEALTH SPORTS REHABILITATION UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD. Initiate rhythmic stabilisation drills in protected positions i.e. Please call your doctor if you are having a problem with your knee or if you need clarification of these instructions. Prevent muscle atrophy. September 27, 2014 by Alicia Rayner. All advice is general and you are advised to consult with your own physiotherapist and coach before undertaking any exercises. It contains detailed exercises appropriate for the different phases of rehabilitation. Use an interval return to throwing program with the intention to return to 100% throwing only at 28 weeks. With a proper MCL injury rehabilitation protocol, even a complete MCL tear should completely heal. Medial Collateral Ligament Repair Protocol-Dr. McClung Brace: ... Do not do any closed chain knee rehab exercises until at least 6 weeks post-op which is when patient is allowed WBAT Stationary bicycle when MD protocol allows at least 105 degrees and patient has no pinching with end range flexion. Rehabilitation after Injury to the Medial Collateral Ligament of the Knee Phase 1: The first six weeks after injury (grade 2 and 3) three weeks after injury (grade 1) The knee should be protected with a short-hinged brace for 3 to 6 weeks, depending upon the severity of the injury. Rehabilitating from ACL or MCL surgery is a long process – and that process begins the moment you awake from anesthesia. Post exercise soreness should be mild and relived within a few hours of stopping exercises, Week 11 onwards: Can start to swim, and walking, stationary bike with brace off. Medial Collateral Ligament (MCL) Rehabilitation Protocol Weeks post-injury 1-2 Weeks Initiate physical therapy. General Guidelines: Immediate Post-op • No passive extension or passive flexion exercises • Gentle AROM or AAROM knee flexion is permitted within MD limitations (usually 90 degree limit for the first 6 weeks and then slow ROM progression as the capsular structures allow- use pain as a guide) • … Return to full work capacity and competitive throwing from 28 weeks, Immobilization in sling with 90 of elbow flexion. ⁦@BSSHand⁩ honouring the late Prof John Stanley. Phase 1: Maximum Protection (0 to 14 Days) Aims: Protect healing tissue. Increased blood flow means more nutrients, proteins, and oxygen and therefore the capacity to heal without surgical reconstruction. Rehabilitation Protocol: ACL and M CL Reconstruction Name: _____ Date: _____ _____ Diagnosis: _____ Date of Surgery: _____ ... o No prone hangs if PCL reconstruction!! Scapular retractors, posterior tilt, and upward rotation with resistance. Continue to avoid running or jumping. The MCL is repaired where it was torn, either distally near … Begin active knee flexion at 6 weeks for ACL/PCL and/or MCL an at 8 weeks for PLC reconstruction. Ì�⇊:'6b&3WáªcVmñÕªåv«¸×å�zi`¯^eı{™ÆÇÕ|F‚f§3¸B)f'ÂÁ⾯•ÛijOüÂG#̛ШÔä*>:_©ó}”o£1Ô#¾IÉ?„x-!ÏÊj.Ó—ºØ„›�„»÷y‹®7èöe%è¶%ˆ±úΦîB_…FÙDçÀ!ã. ‹ÉíšD�‚àà…¶†`Sâø'è{1ØæQbûມLÛö Öá³LdV2Ká¾Èª,ÊĞ¡7Õ1Ôci'(üÔ7wù`Û¡ßØ…»„(”“S$¬E¢.4¦3s'ªoÂGæâ9�¹ãä? The exercises will help to strengthen the muscles around the knee and help you to regain full range of movement. 4. 5. In forearm supination active wrist flexion and extension ROM. Most MCL tears are treated non-surgicallywith rest, bracing, and physical therapy. Surgery uses an allograft or autograft to reconstruct the torn ACL ligament arthroscopically. Stationary bike (low resistance, high seat, with NO toe clips – so as to prevent hamstring contraction) Mini-squats to 45 degrees. Shoulder girdle pro- and re-traction. To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. Injuries to this ligament tend to occur when a person is bearing weight and the knee is forced inwards, such as slipping on ice or playing sports, e.g. Control the speed of the movements carefully, Running and sprinting can be introduced gradually. MCL rehab time refers to the time it takes for a person to complete a full MCL rehabilitation program. Initiate plyometrics starting with 2 hand drills first further from the body, Increase strength and power and endurance of upper limb musculature. MCL Rehabilitation- From Ruin to Return to Play. MCL reconstruction,7 and a recent systematic review showed that there is a role for primary repair in patients with MCL injuries.8 In this article we describe the surgical technique of primary MCL repair with internal bracing that can be used in the setting of isolated MCL injuries, combined ACL-MCL injuries, or multi-ligamentous knee injuries. Copyright 2012 ElbowDoc | All Rights Reserved | Website by, Rehabilitation after medial ligament reconstruction – throwers, Rehabilitation after Distal Biceps Tendon Repair, Rehabilitation after Release of Stiff Elbow, Rehabilitation Tennis / Golfers Elbow Release, Lateral Ligament Reconstruction Rehabilitation, Avoid valgus force or position during exercises. Initiate elbow ROM: Precautions: Avoid valgus force or position during … ⁦@uplimb⁩ proud to carry on his ethos ⁦@WWLNHS⁩. 90% (9 out of every 10) of ACL reconstruction patients have a ‘successful’ reconstruction, whereas only about 60-70% (6 or 7 out of 10) of patients will feel similarly satisfied after PCL reconstruction. Associate Professor of Orthopaedics Chief - Division of Sports Medicine Tel: (212) 598-6784 Rehabilitation Protocol: ACL, MCL and PCL Reconstruction Perform bike with low … That’s because the MCL, unlike other ligaments like the Anterior Cruciate Ligament (ACL), has a great blood supply. shoulder rotations in neutral and in abduction and scaption. Maintain shoulder ROM, introduce 90% of gentle active shoulder ER. no risk of infection from perspiration), Restore/maintain full elbow range of motion. Crutches and restricted weight bearing may be needed, as instructed by the doctor. ANTERIOR CRUCIATE LIGAMENT (ACL) WITH MENISCUS REPAIR POST-OP REHABILITATION PROTOCOL The following is a protocol for postoperative patients following ACL reconstruction and meniscus repair (medial or lateral). Shoulder girdle elevation and depression. Please note this protocol … Begin the following at 6 weeks for ACL/PCL and/or MCL and at 8 weeks for PLC recon. Medial Collateral ligament (MCL) Lateral collateral ligament/Posterolateral Corner (LCL/PLC) This specific rehabilitation protocol should be used when both the ACL and PCL are reconstructed, along with one or more of the other ligaments. Surgeon, trainer, leader, pioneer and friend to people all over the world. Consider brace for exercise and periods of activity if severe sprain and/or patient has pain. Leg press to 60 degrees. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving pre-injury level of activity. Light resistance ex for arm (half one lbs): wrist curls and extensions, forearm pro- and supination, elbow extension and flexion. Isotonic shoulder and scapular strengthening avoiding valgus stress, Start isotonic shoulder ER strength (hand stays on medial side of elbow to avoid valgus strain), Walking and stationary bike with sling on permitted. Regain and improve muscular strength as a secondary goal. https://www.physio-pedia.com/Medial_Collateral_Ligament_Injury_of_the_Knee Introduce one hand plyometric 90/90 throws, Initiate interval throwing program based on advice below and particular to type of sport, Dynamic neuromuscular control with shoulder stabilisation, Strengthen the muscles involved in throwing, with attention to core. Surgi… Introduce upper limb weight bearing into isometric holds in the press up and push up positions. No significant difference in functional outcome, degree of stability, or isokinetic muscle torque … Towards end of week 3 progress slowly on to full elbow ROM as tolerated, Whole body motion with core work while in sling, Shoulder isometrics (IR, abd, and biceps, avoid resisted shoulder ER). Really enjoying excellent talks on scaphoid fractures from a fantastic faculty. Avoid valgus strain. Rehab to include: Shoulder PROM/AAROM flexion, ABD, IR, ER (rotation 0-45 ABD) AROM/RROM hand, wrist, elbow; Gentle IR behind back; Isometric scapular retraction/depression ; Intermediate Phase (6-8 weeks post-operative): Discontinue sling at 6 week follow up with Dr. LaFrance. To download protocol please click here. The rehabilitation protocols are very different from ACL reconstruction and the outcomes are less good. Start throwing. Please refer to the guidelines for interval return to throwing program. This generally will not occur until 6-8 weeks post-op. Medial Collateral Ligament and MPFL Repair Rehabilitation Protocol . Decrease pain and inflammation. Rx. Two-armed rebounder drills, progressing to one-armed off a wall. But no treadmill and no running or jarring activities (ensure that  incision is closed i.e. ACLR + MCL reconstruction surgery post-operative protocol ACL Reconstruction and MCL Repair occur after a contact or non-contact knee injury when the ACL and MCL are both fully torn, often with involvement of the medial meniscus. Injuries to the MCL are usually caused by aforce that pushes the knee sideways, often occurring as a result of a directblow to the outside of the knee that pushes the knee inward (toward the otherknee). All advice is general and you are advised to consult with your own physiotherapist and coach before undertaking any exercises. • MADISON, WI 53718 Rehabilitation Guidelines for Elbow Ulnar Collateral Ligament (UCL) Reconstruction The elbow is a complex system of three joints formed from three bones; the humerus (the upper arm bone), the ulna (the larger bone of … Post-operative Rehabilitation Protocol Knee Multiple Ligament Injury Reconstruction / Repair (ACL, PCL, +/- MCL, LCL, or PLC) The goals of this protocol are to protect the reconstructions while preventing knee stiffness. NO SHOUDER EXTERNAL ROTATION. Whether you injured your knee on the slopes, in the gym, on the field or from a slip and fall, getting back to 100% after knee surgery can feel like an uphill battle.. More often than not, that’s because it is. Isolated MCL Repair / Reconstruction Postoperative Rehabilitation Protocol Dr. Jeffrey Witty, M.D. You may vary in your ability to do these exercises and to progress from one phase to the other. This can result in a partial or complete tear of the ligament. meniscus repair) - AVOID valgus force to knee during rehab exercise - No aggressive PROM to avoid stretching graft tissue - PT to educate and observe patient to … of modalities for pain and swelling as needed. Honoured to speak tonight on @HandSociety webinar talking about elbow disasters. Active shoulder flexion and abduction ROM in the sling keep forearm in 90 degrees flexion and in supination. Other structures such as the menisci may also be repaired which can alter the rehabilitation guidelines. UW HEALTH SPORTS REHABILITATION UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD. In supine lying, active elbow flexion and extension 30 to 120 with forearm supination. ROM exercises are gentle active or active assisted. Dr. Rolf . It lies on the inner side of your knee joint, connecting your thigh bone (femur) to your shin bone (tibia) and provides stability to the knee. Surgical Technique In this article and in … Gentle ROM's. Author: Tanya Anne Mackenzie, Manchester Shoulder Clinic. Patient will wear immobilizer for 2 weeks following injury, except in P.T. In an MCLinjury, you feel the pain on the inside of your knee. Grade 2 Rehab: MCL rehab … Progress from 2 arms in sagittal plane to 1 arm in the sagittal plane, then to 2 arm rotational movements then 1 arm rotational movements). on your rehabilitation after reconstruction of your anterior cruciate ligament (ACL). (ACL) reconstruction. Lateral Collateral Ligament Reconstruction Rehab Protocol The lateral collateral ligament, or LCL is probably the least often injured ligament of the knee. ELBOW MCL RECONSTRUCTION REHABILITATION PROTOCOL RANGE OF IMMOBILIZER THERAPEUTIC MOTION EXERCISE PHASE I Passive ROM to tolerance Brace locked at 0 - 90 and to Scapular stabilizing exercises, gentle 2 - 4 weeks be worn at all times rotator cuff strengthening, gentle hand/ wrist/shoulder ROM PHASE II Begin AAROM to full flexion* Brace … In general, a hinged brace with a slight varus mold is used for the first 6 weeks. If there is soreness after throwing it should be mild and subside within a few hours.
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