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Document Title: Reider-AJSM-Jul93.shtml
Article Title: Treatment of Isolated Medial Collateral Ligament Injuries in Athletes with
Early Functional Rehabilitation -- A Five-year Follow-up Study
Authors: Bruce Reider MD, Michael R. Sathy MD, James Talkington MD, Nestor Blyznak MD, and
Stephen Kollias MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: July 1993
Volume 22, No. 4, pages 470-477
Keywords: MCL injuries, non-operative treatment versus surgery, bracing.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: In this classic study, Reider et al. found that MCL injuries, even those of considerable severity, are capable of "self-healing" (i.e. scarring over on their own, and thus providing an adequate restraint to inwards forcing). The results are comparable to surgical repair of the MCL. The only caveat with non-surgical rehabilitation and early return-to-activities is that care must be taken to shield the injured MCL from sideways forcing. A functional brace is well-suited to this task. (In this study, low-end prophylactic-type single-upright braces were used; such braces are helpful but not ideal if return-to-sports use is expected. Dual-upright functional braces are stronger and more durable, particularly if subjected to sideways forcing, for example in contact situations of sports.) The authors do note that, even though the self-healing brought good results, persistent symptoms can remain...and so the athlete might want to continue to make use of bracing during knee-demanding activities. Reider et al. make it clear that, despite the MCL's capability for self-healing, this injury is not a trivial one.
ABSTRACT
A prospective study was designed to provide 5-year followup of the treatment of isolated grade III sprains of the medial collateral ligament with early functional rehabilitation in 35 athletes. After injury, patients were placed in lateral hinged braces to provide valgus support without restricting flexion or extension of the knee. Treatment was initiated with range of motion exercises performed in a whirlpool or swimming pool. Patients were then started on quadriceps setting and leg raises. When 90 degrees of flexion was present, resistive exercises were added. Upon recovery, patients were allowed to return to unrestricted sports. Followup consisted of both questionnaires and physical examination and was graded on the 50-point Hospital for Special Surgery scale. Mean followup was 5.3 years (range, 2.5 to 8); mean Hospital for Special Surgery knee rating score was 45.9 points (range, 41 to 50). These results are comparable with those achieved with surgery or immobilization by earlier investigators. Thus, early functional rehabilitation treatment of complete medial collateral ligament sprains produces results comparable with those achieved with surgery or immobilization while minimizing treatment-related morbidity and allowing more rapid return to sports participation.
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