A 16-year-old high school football player was injured when he was hit on the lateral side of the right knee while running with the football. He immediately fell to the turf and was unable to bear weight on his right leg. He did not return to play. After a sideline examination, the team doctor diagnosed him with a grade II medial collateral ligament sprain. The football player's goal is to return to play as soon as possible.
What examination signs may be associated with this diagnosis?
What are the most appropriate examination tests?
Based on his diagnosis, what do you anticipate will be the contributors to activity limitations?
What are the most appropriate physical therapy interventions?
What are the most appropriate physical therapy outcome measures for return to sport?
What is his rehabilitation prognosis?
GRADE II LIGAMENT SPRAIN: Ligament injury that involves tearing of 25% to 75% of the ligament; signs and symptoms include pain, swelling, loss of motion, and possible joint instability
MEDIAL COLLATERAL LIGAMENT (MCL): Major ligament of the knee that maintains medial stability
VALGUS STRESS: Force applied to the lateral side of a joint that creates tensile stress to the medial joint
Describe the anatomy of the medial collateral ligament of the knee.
Identify the most accurate clinical tests for assessing an MCL sprain.
Differentiate between the different grades of MCL sprains.
Prescribe appropriate therapeutic exercises for an individual with a grade II MCL sprain.
Describe the functional tests needed for return to sport after an MCL sprain.
PT considerations during management of the individual with a diagnosis of a grade II medial collateral ligament sprain:
- General physical therapy plan of care/goals: Decrease pain; increase joint range of motion; increase lower quadrant strength; prevent or minimize loss of aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease pain; muscular flexibility exercises; resistance exercises to increase muscular endurance capacity of the core and to increase strength of lower extremity muscles; aerobic exercise program; knee brace
- Precautions during physical therapy: Monitor vital signs; address precautions or contraindications for exercise, based on the stages of healing
- Complications interfering with physical therapy: Excessive swelling; excessive scarring that limits normal knee range of motion
Knee injuries are common in sporting activities. According to the American Association of Orthopaedic Surgeons (AAOS), in 2003 approximately 19.4 million individuals sought medical treatment for knee injuries and one of the most commonly injured ligaments is the medial collateral ligament (MCL).1,2 Anatomically, the MCL complex contains three components: the superficial MCL (sMCL), the deep MCL (dMCL), and the posterior oblique ligament ...