REHABILITATION TECHNIQUES FOR LIGAMENTOUS AND MENISCAl INJURIES

Medial Collateral Ligament Sprain Pathomechanics, The MeL is the most commonly injured ligament in the knee. 7S About 63 percent of MeL sprains occur at the proximal insertion site on the femur. Individuals with proximal injuries tend to have more stiffness but less residual laxity than those with injuries nearer the tibial insertion. Tears of the medial meniscus are occasionally associated with grades 1 and 2 MCL sprains but almost never occur with grade 3 sprains, Diagnosis of MCL spnlins can usually always be made by physical evaluation and do not generally require MRl. The grade of ligament injury is usually determined by the amount of joint laxity. In a grade 1 sprain the MCL is t.ender due to microtears, but has no increased laxity and there is a firm end point. A grade 2 sprain involves an incomplete tear with some increased laxity with valgus stress at 30 degrees of Ilexion and minimal laxity in full extension, yet there is still a firm end point. There is tenderness to palpation. hemorrhage. and pain on valgus stress test. A grade 3 sprain is a complete tear with significant laxity on valgus stress in full extension. No end point is evident. and pain is generally less than with grades 1 or 2. Signit1cant laxity with valgus stress testing in full extension indicates injury to the medial joint capsule and to the cruciate ligaments .'l