Mcl nonoperative treatment grade i, ii, iii isolated mcl sprain rehabilitation guidelines note. For grade 2 and particularly grade 3 mcl sprains, it is important that the ends of the ligament are protected and left to heal without continually being disrupted. Mcl sprain rehabilitation protocol medial knee ligament sprain. Medial collateral ligament sprain brigham and womens hospital. Nonoperative mcl tear rehabilitation protocol the intent of this protocol is to provide the clinician with a guideline for a nonoperative rehabilitation course of a patient with an isolated medial cruciate ligament injury. In grade 2 sprains, damage has occurred to the individual ligament fibers and is sometimes referred to as a partial or incomplete tear.
A grade iii sprain is complete rupture of the ligament, resulting from severe valgus force. Fortunately mcl sprains of this magnitude can heal without surgical intervention, especially if the medial meniscus remains uninvolved. A grade 2 tear can take from two to four weeks to heal. Mcl sprain rehabilitation protocol medial knee ligament. Modalities to control inflammation l prescription antiinflammatories. Rehabilitation after injury to the medial collateral.
Rehab protocols list of protocols click here to download pdf. Rehabilitation after injury to the medial collateral ligament of the. Muscle most commonly affected is long head of the biceps femoris, usually just proximal to the musculotendinous junction 616 cm proximal to the knee joint. Medial collateral ligament mcl rehabilitation protocol weeks post injury 1 2 weeks initiate physical therapy. Mcl sprain rehab protocol for a grade 1, 2 and 3 medial knee ligament sprain. There will be significant swelling with a grade 3 injury and it is often difficult to bend the knee, although it is sometimes less painful than a grade 2 sprain. This program may be accelerated for grade i mcl sprains or may be. The medial collateral ligament usually responds well to nonsurgical treatment.
Restrict motion to sagittal plane until week 46 to allow healing of mcl. Acute stage, subacute stage and late stage sports specific rehabilitation. Its also a good idea to know your test results and keep a list of the medicines you take. Management of the patient with an aclmcl injured knee. Medial collateral ligament mcl rehabilitation protocol. Rehabilitation after injury to the medial collateral ligament of the knee phase 1. Grade iii tears may have an immobilization period prior to onset of rehabilitation, per provider order. Grade 2 mcl injury with or without meniscus damage acl surgery within two weeks. On average, it takes six weeks for a mcl injury to heal. Independent weight bearing as tolerated gait pattern with use of crutches and brace on if. Grade 1 is a mild sprain, grade 2 is moderate and grade three severe or complete tear of the ligament. The following schedule serves as guidelines to help in the expediency of returning a patient to his or her preinjury state.
Rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage. If surgical repair or reconstruction of the mcl is required, rehabilitation will respect. Pdf on dec 1, 2016, catherine a logan and others published post operative rehabilitation of grade iii medial collateral ligament injuries. Mcl nonoperative treatment grade i, ii, iii isolated mcl. In the midst of some form of activity, you likely twisted or turned your knee at a bad angle, and heard a loud pop. There could also be laxity at full extension, indicating damage to the deeper, capsular fibres of the mcl. The first six weeks after injury grade 2 and 3 three weeks after injury. As you work through the initial stages of recovery, and your knee begins to heal, start to introduce some very gentle movements, using light stretches and rotations to reduce the build up of scar tissue and allow greater flexibility at the injured part. Acute stage, subacute stage and late stage sports specific. The medial collateral ligaments 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. Durants sprain is a grade 2 injury, a more moderate sprain.
When this happens, you face a recovery time of weeks to months, depending on the grade of the mcl tear. Rehabilitation of isolated mcl sprains this program may be accelerated for grade i mcl sprains or may be extended depending on the severity of the injury. Rehabilitation guidelines for posterior cruciate ligament. Patient will wear immobilizer for 2 weeks following injury, except in p. The mcl, unlike other ligaments like the anterior cruciate ligament acl, has a great blood supply. Grade 2 and 3 injuries locked in extension x 1014 days prior to initiating physical therapy and then limited 090 degrees for an additional 2 weeks. Knee meniscus tear tests and exercises for full recovery. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. Rehabilitation guidelines for knee multiligament repair uw health. If there is any increase in pain or swelling or loss of rom, these can serve as signs that the progression of the. Range of motion and strengthening exercises brace off.
A grade 3 mcl tear is when the ligament ruptures i. Youre likely reading this because you are on the receiving end of a pretty crummy feeling. A grade iii injury is a complete tear of the mcl complex. Phase 1 begins immediately following injury and may last 4 weeks. With a proper mcl injury rehabilitation protocol, even a complete mcl tear should completely heal. Mcl knee sprain grade iii adopted 298, revised 204, revised 109 1 general principles. The first six weeks after injury grade 2 and 3 three weeks after injury grade 1 the knee should be protected with a shorthinged brace for 3 to 6 weeks, depending upon the severity of the injury. Hamstring rehabilitation guidelines an evidence based approach. Mcl injury rehabilitation and management considerations.
The above program may be accelerated for first degree mcl sprains or may be extended depending on the severity of the injury. The medial collateral ligament mcl on the inner side of the knee is most often torn when there is a force that strikes the outside of the knee. Here we outline an lcl sprain rehabilitation program for grade 1, 2 and 3 lateral knee ligament sprains. Figure 2 medial inside view of the knee image property of primal pictures. Click here to download pdf activities and exercises after injury to the medial collateral ligament mcl of the knee. Knee, hip hamstring injuries are at the high incidence rate in various field sports which require powerful accelerations, deceleration or explosive movements, in every year around the world. The majority of mcl tears are isolated injuries and many times are treated nonoperatively. Mcl rehabilitation from ruin to return to play rayner.
No open chain hamstring strengthening or isolated hamstring exercises. Shelbourne treated 22 isolated grade 1 and grade 2 pcl injuries with extension bracing for six weeks. Medial collateral ligament mcl rehabilitation protocol weeks postinjury 12 weeks initiate physical therapy. The postoperative rehabilitation protocol for grade iii mcl injuries employed at the authors institution. An isolated grade i, firstdegree tear presents with localized tenderness without laxity. The first six weeks after injury grade 2 and 3 three weeks after injury grade 1. In the case of an isolated acl tear with no other ligamentous or cartilage involvement, the associated pain and dysfunction can be successfully treated with physical. A grade 3 tear usually takes from four to eight weeks to heal, unless it is associated with damage to the acl, in which case the. Mcl injury campus recreation university of nebraskalincoln. With the assumption that totaps talk, observe, touch, active movement, passive movement, skills test has been completed at the sight of the injury, ricer should now be followed.
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. Increased blood flow means more nutrients, proteins. Anterior or front view of the knee showing the anterior cruciate ligament. Posterior cruciate ligament rehabilitation protocol. The first six weeks after injury grade 2 and 3 three weeks after injury grade 1 the knee should be protected with a shorthinged brace for 3 to 6 weeks. Easy stationary bike for range of motion roms, quads, straight leg raises slrs, calf raises. Rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap. Anatomy and biomechanics the knee is a hinge joint connecting the femur and tibia bones. The initial treatment for most grade 1, 2 or 3 mcl tears focuses on reducing the pain and inflammation in the knee while immobilizing the knee to keep it stabilized. The focus of this rehab protocol is on slow progressions of rom, especially flexion. Regaining a full range of motion of the knee joint is the first priority in this phase of the rehabilitation process. It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. This will vary from patient to patient depending on a number of factors including the grade or severity of the injury.
But you dont have to be a pro athlete to suffer an mcl injury a pickup game in hoops or football can leave you hobbling home. Isolated grade i and ii tears table 1 and nondisplaced pcl bony. No patellofemoral joint pain gross manual muscle testing strength 90100% of contralateral side. A grade 1 ligament sprain is a minimal injury with little to no increase in laxity. This protocol is intended to provide a general guideline. Hamstring rehabilitation guidelines an evidence based. If there is any increase in pain or swelling or loss of rom, these can serve as. Modifications to this guideline may be necessary dependent on physician specific instruction, degree of the tear, specific tissue healing timeline, chronicity of.
A minor, or grade 1, mcl tear can take from a few days to a week and a half to heal sufficiently for you to return to normal activities, including sports. The mcl attempts to resist widening of the joint and tears if the force is too great. When the mcl is a pain when a force overpowers the mcls. The correct postinjury rehabilitation exercises for a grade 2 mcl sprain can significantly decreases the risk of reinjury. Followup care is a key part of your treatment and safety. The following schedule serves as guidelines to help in the expediency of returning a patient to his or her pre injury state. On examination, there is tenderness over the mcl, with severe laxity on valgus stress testing without a distinct endfeel. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. Restoring quadriceps function phase i inflammatory phase. Patient can pass single leg hop test for distance, single leg squat test, and figure. Achieving the criteria of each phase should be emphasized more than the approximate duration. Injuries to the medial collateral ligament most often happen when the knee is hit directly on its outer side.