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EXPERT ADVICE: Frequently Asked Questions
Ligament Damage
Q: What exercises should be avoided when an injury to the LCL or MCL is found. I know that quick "cuts" laterally should be avoided, but are there any exercises to avoid in a gym setting?
Answered by Jack Farr M.D. on March 20, 2002
A: All Ligaments have their own specific guidelines and within group the extent of injury also dictates management (grade 1, 2, & 3). So, unfortunately, there is no one single answer. As always, you must know the pathology before initiating treatment.
 
Q: My son had a minor fall from his bike about a month ago and began having pain around the knee. Our doctor said his kneecap was loose and moved side to side, that this probably has been this way since birth and the fall aggravated it. He said it wasn't serious and that the ligaments needed to be strengthened. My son is still having some pain and stiffness and it causes him to limp, can you suggest any exercises he could do to strengthen the ligaments and do you think wearing a cloth knee brace would help him?
Answered by Jack Farr M.D. on March 20, 2002
A: A "minor fall" can, at times, cause a major injury. Although ligaments do response to use with some degree of increase strength it is not in the same context as muscle. Ligaments heal typically with scar and if the patella-restraining ligament is allowed to heal in a loose position, there may be more patellar instability in the future. Only your knee expert can guide management at this point.
 
Q: I was involved in a motorcycle accident. It has been four days and my knee is still swollen. I was taken to the hospital ER and had an x-ray. The doctor said I may have damaged my knee ligaments, but the injury was too fresh and swollen to know anything for sure. Can you tell me about the symptoms of a torn ligament?
Answered by Joshua Siegel M.D.
A: Swelling and pain are symptoms of a torn ligament. Many times, it is difficult to bend the knee and oftentimes there is quite a bit of swelling within the knee itself. Many patients will complain of a feeling of instability when attempting to place weight on their leg, in addition, it may feel like the knee is buckling.
 
Q: I hurt my medial collateral ligament six weeks ago in a skiing accident. I still have substantial pain, stiffness, and a limited range of motion despite my physical therapy. I was curious as to how long it takes for injuries such as these to heal.
Answered by Joshua Siegel M.D.
A: Although each patient is unique, generally, most patients with appropriate physical therapy begin to heal in three weeks and, generally, have completed their healing by three months. If there is still residual medial-sided knee pain, one must consider that there is a possibility of torn cartilage, which continues to limit the range of motion and cause substantial pain.
 
Q: I recently had an MRI done of my knee and the doctor discovered that I had a grade II tear of my LCL. I am a professional soccer player and it's the middle of the season. Can you tell me what I should do to rehab my knee and what type of brace I should wear, if any?
Answered by Joshua Siegel M.D.
A: Generally, to rehabilitate this knee, I would recommend that the patient undergo aggressive range of motion exercises and strengthening of the quadriceps and hamstrings to
re-establish stability. Braces, in and of themselves, have not been shown necessarily to protect the knee even with physiologic locking, however, they may benefit proprioceptive mechanisms allowing the patient to know where their knee is in space to better fire their muscles to protect it. The recommendation would be not to play until you have a pain-free range of motion and are able to perform cutting exercises without pain.
 
Q: I have injured multiple ligaments in my knee; however, all the information that I have found only pertains to treatment of isolated ligament injuries. What kind of treatment and rehab is involved in multiple-ligament injuries?
Answered by Joshua Siegel M.D.
A: In addition to regaining quadriceps and hamstring control the rehabilitation for multiple-ligament injuries includes an aggressive range of motion program and an attempt to reduce swelling. Depending on exactly which ligaments are injured, oftentimes surgical intervention and repair or reconstruction are the only alternatives to re-establishing knee stability and regaining functional capacity. Depending on exactly which ligaments are injured, the spectrum of treatment ranges from conservative treatment to aggressive surgical treatment.
 
Q: I tore my ACL and LCL as a result of a skiing accident. My orthopaedic surgeon told me that I only need to wait two to three weeks before surgery; however, my physical therapist feels that the surgery should take place immediately. What is the standard time between injury and surgery to repair torn ligaments?
Answered by Joshua Siegel M.D.
A: The anterior cruciate ligament can be repaired electively after full range of motion has been regained and swelling has subsided. However, generally waiting more than two or three months can lead to a chronic instability, which may make the results over time more predictable than those that are treated before this time period. With the lateral collateral ligament injury added to the anterior cruciate ligament injury, generally, you should be operated on earlier rather than later, as the lateral collateral ligament can still be repaired, if done accurately. If the lateral collateral ligament injury is left untreated for more than three or four weeks, it becomes more difficult to repair and many times has to be reconstructed with tendons or ligaments from your own body or that of a cadaver. This is much more difficult technically, and may yield somewhat less predictable results.
 
Q: After being injured in a car accident, I was told that the ligaments of both my knees were stretched to the point of no elasticity. I have heard of lasers that help correct weakened ligaments. Do you have any input in this new technology and its effectiveness?
Answered by Joshua Siegel M.D.
A: Physicians have begun working with thermal energy that is delivered through lasers or radio frequency devices. These devices heat tissue up to the point where the collagen shrinks and re-establishes the tightness that is necessary to control knee motion. This is still somewhat experimental and long-term studies are not out yet. It is akin to lighting a match to Saran Wrap, causing the shrinkage of that particular tissue and re-establishing stability. It is yet to be seen whether new collagen grows on top of this that allows this repair to be permanent or whether this is just temporary in nature.
 
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