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Treatment of medial knee injuries varies depending on location and classification of the injuries. The consensus of many studies is that isolated grade I, II, and III injuries are usually well suited to non-operative treatment protocols. Acute grade III injuries with concomitant multiligament injuries or knee dislocation involving medial side injury should undergo surgical treatment. Chronic grade III injuries should also undergo surgical treatment if the patient is experiencing rotational instability or side-to-side instability.
Treatment of posterolateral corner injuries varies with the location and grade of severity of the injuries. Patients with grade I and II (partial) injuries to the posterolateral corner can usually be managed conservatively. Studies have reported that patients with grade III (complete) injuries do poorly with conservative management and typically will require surgical intervention followed by rehabilitation.
Arthrofibrosis of the knee has been one of the more studied joints as a result of its frequency of occurrence. Beyond origins such as knee injury and trauma, arthrofibrosis of the knee has been associated with degenerative arthritis. Scar tissues can cause structures of the knee to become contracted, restricting normal motion. Depending on the site of scarring, knee cap mobility and/or joint range of motion (i.e. flexion, extension, or both) may be affected. Symptoms experienced as a result of arthrofibrosis of the knee include stiffness, pain, limping, heat, swelling, crepitus, and/or weakness. Clinical diagnosis may also include the use of magnetic resonance imaging (or MRI) to visualize the knee compartments affected.
The consequent pain may lead to the cascade of quadriceps weakness, patellar tendon adaptive shortening and scarring in the tissues around the knee cap—with an end stage of permanent patella infera—where the knee cap is pulled down into an abnormal position where it becomes vulnerable to joint surface damage.
Patients who are recognized as developing arthrofibrosis may improve motion with appropriately directed physical therapy, corticosteroid injections, non-steroidal anti-inflammatory drugs, and cryotherapy. In many instances, however, as fibrosis has set in, surgical intervention is necessary. Specialized arthroscopic lysis of adhesions knee procedures such as anterior interval releases may be indicated and utilized to great success, in the hands of an appropriately trained specialist.
Rehabilitation protocols for post-op patients with repaired or reconstructed posterolateral corner injuries focus on strengthening and achieving full range of motion. Similar to nonoperative treatments, the patient is non-weightbearing for 6 weeks followed by a return to partial weight-bearing on crutches. Range of motion exercises begin first at 1 to 2 days postoperatively, followed by progressive strength training. Patients can typically begin riding a stationary bike and using a quadriceps machine around 6 to 8 weeks, but isolated hamstring exercises should be avoided for a minimum of 4 months postoperatively. Patients can progress to leg presses after 6 weeks, but the weight should be very light. Jogging and more aggressive strength training can begin around 4 – 6 months at the surgeon and physical therapists discretion. Patients should not be casted after surgery unless absolutely necessary.
Conservative treatment of isolated medial knee injuries (grades I-III) begins with controlling swelling and protecting the knee. Swelling is managed well with rest, ice, elevation, and compression wraps. Protection can be performed using a hinged brace that stabilizes against varus and valgus stress but allows full flexion and extension. The brace should be worn for the first four to six weeks of rehabilitation, especially during physical exercise to prevent trauma to the healing ligament. Stationary bike exercises are the recommended exercise for active range of motion and should be increased as tolerated by the patient. Side-to-side movements of the knee should be avoided. The patient is allowed to bear weight as tolerated and should perform quadriceps strengthening exercises along with range of motion exercises. The typical return-to-play time frame for most athletes with a grade III medial knee injury undergoing a rehabilitation program is 5 to 7 weeks.
Arthrofibrosis (from Greek: "arthro-" joint, "fibr-" fibrous and "-osis" abnormality) is a complication of injury or trauma where an excessive scar tissue response leads to painful restriction of joint motion, with scar tissue forming within the joint and surrounding soft tissue spaces and persisting despite rehabilitation exercises and stretches. Scarring adhesions has been described in most major joints, including knees, shoulders, hips, ankles, and wrists as well as spinal vertebrae.