Group 7.

Strain/sprain of MCL, LCL

The following questions should be answered

1. What is a classic history or capsule summary for this presentation? Specifically a typical
mechanism of injury and the typical aggravating and relieving factors.

Usually a traumatic injury that involves a valgum or varum force applied to the knee.

Often involved with trauma of meniscus and ACL.

Pain in flexion, extension and weight bearing.

2. What red flags and other conditions you need to eliminate? (include systemic and peripheral
presentations.

Osteosarcoma, chondrosarcoma, Ewing’s sarcoma – these all usually affect people 25 and under.

Septic arthritis

Salter-Harris fracture

3. What outcome assessments would you use?

KOOS

4. If there is a grading scale, can you briefly describe it?

Grade 1. Mild aggravation to the ligament, pain but no laxity when challenged, 2 – 4 week healing
time.

Grade 2. Partial tear to the ligament, strong pain when ligament is challenged but no laxity, 4 – 12
week healing time.

Grade 3. Full rupture of ligament, pain and laxity of ligament when challenged, 3 – 12 month healing
time.

5. What imaging techniques would you use and why?

MRI – due to its high sensitivity to soft tissue injuries

6. On the provided Images, please indicate the pathology and describe it?

Very hard to see but there might be a slight tear in the MCL

7. What relevant orthopaedic, quantitative and qualitative tests would you use? Demonstrate one of
each on the patient to the class.

Valgus & Varum stress tests

Appley’s distraction

Appley’s grind, bounce home & lockman’s to help rule out

8. Outline your management strategy including chiropractic and other techniques, treatment plan;
including your visit schedule, home advice, exercises and progressions. Include expectations of what
they can achieve at relevant time frames and what exercises you would use in the relevant time
frames.

0 – 4 Weeks 4 – 12 Weeks 3 – 12 Months

Chiropractic Adjust or mobilise if Adjust or mobilise if Adjust or mobilise if
techniques required required required

Visit schedule 2 x per week 1 per week When required

Home advice Crutches if required Avoid aggravating Monitor the knee and
Strapping if required movements make sure you are not
Elevate and ice if Ice and heat to doing anything that
swollen promote blood flow aggravates the knee
Exercises Range of motion Gentle squatting Return to normal
cycling without weight. exercise but not full
Balance board squats sport until 12 months
Leg extension if a full tear was
sustained
Timeframes for Grade 1 Grade 2 Grade 3
recovery