Care and treatment
FIRST AID: if you have suffered a knee sprain, you must immediately apply the RICE protocol:
- Rest: Rest the knee and immobilize it
- Ice: apply ice to the joint for no more than 20-30 minutes
- Compression: Compress the knee with an elastic bandage
- Elevation: Elevate the joint by placing it in the drain
In this way you will be able to stop the bleeding responsible for local swelling and pain. Each application of ice will last approximately 15-20 minutes (not over) taking care to put a thin fabric to protect the skin. Repeat the application every three or four hours for two or three days until the pain is significantly reduced.
After the visit, the doctor may prescribe the classic non-steroidal anti-inflammatory drugs (NSAIDs) to further alleviate the swelling and reduce the pain.
The doctor may decide to perform an arthrocentesis by introducing a small cannetta into the joint cavity and aspirating the liquid contained in it. Aspiration of blood helps reduce pain and promotes diagnosis. After the arthrocentesis, a liquid sample can be sent to a specialized laboratory to exclude the presence of an infection
Usually the knee sprains are treated with a conservative treatment without resorting to surgery that is necessary only if there is a strong articular instability.
The standard rehabilitation program involves strengthening the muscles of the anterior thigh region (quadriceps). The strengthening of these muscles will help to stabilize the joint more and reduce the risk of new distortions.
Two or three days after the injury, warm compresses can be applied to reduce local pain and stiffness. Other physical therapies with possible beneficial effects include ultrasound, iontophoresis, laser and tecar therapy.
If the patient has suffered a DISTORTION to the knee of THIRD DEGREE (complete rupture of the ligaments) the treatment depends on the specific type of injury.
Distortion of the anterior cruciate ligament : a complete lesion hardly goes against spontaneous healing due to the clear separation and removal of the two ends of lesion.
The injured ligament can be surgically reconstructed using a part of the patellar tendon (2 times more resistant than the ACL) or by taking tissues from the tendons of the gracilis and semitendinosus muscle (together they are 4 times more resistant than the ACL). It is not necessary to operate in urgency since better results are obtained when the acute phase has been overcome and the patient has prepared physically to prevent postoperative muscular hypotrophy. The procedure is usually performed in arthroscopy.
The conservative approach is indicated for semisedentarie and elderly people.
Posterior cruciate ligament distortion : the treatment of complete posterior cruciate lesions is rather complicated. Fortunately this type of accident is quite rare (5-10% of all serious ligament injuries of the knee). If an isolated internal laceration occurs, conservative treatment is often attempted, with particular attention to strengthening the quadriceps muscle. In the case of bone avulsion (detachment of the small bone segment into which the tendon is inserted), proceed with the operation of open surgical anchorage using a screw or suture. If conservative treatment fails and chronic instability is present, the hypothesis of arthroscopic reconstruction surgery must be evaluated.
Distortion of the medial collateral ligament : usually conservative treatment characterized by initial immobilization with guardian, physical therapy and rehabilitation is chosen. The medial collateral ligament tends to heal spontaneously. During the immobilization period, in the less serious cases, the load can be granted. Sometimes (third-degree injuries) the suturing or reinforcement surgery is chosen.
Associated distortion of LCA and LCM : requires surgery to reconstruct the crusader and repair the medial collateral. In a first phase a conservative treatment will be carried out with a functional rehabilitation program for the LCM; then we will proceed to the surgical reconstruction of the anterior cruciate.
Distortion of the lateral collateral ligament : conservative treatment characterized by physical therapy and rehabilitation is usually chosen. The lateral collateral ligament tends to heal spontaneously.
Sometimes (third-degree injuries), suturing or reinforcement surgery with allograft or ischiocrural tendon is chosen.
The rehabilitation program varies according to the treatment and the type of injured ligament. Regarding the rehabilitation after injury of the anterior cruciate ligament you can refer to the following articles:
Conservative treatment after lesion of the anterior cruciate ligament
Re-education after surgical reconstruction of the anterior cruciate ligament
EXAMPLES OF EXERCISES for the isometric strengthening of the quadriceps after distortion at the knee in the case of conservative treatment:
Early multi-angle isometric contractions
Extensions of the lower limb: seated on the ground, with the injured leg extended and adherent to the ground, the other bent. Contract the quadriceps muscles to lift the injured limb by 20 cm keeping the knee fully extended. Hold for 10 seconds, relax and repeat 3 times
Sitting in a chair with the lower limb slightly raised so that, while keeping the knee slightly bent, the ankle and hip are at the same height. Imagine tightening a chalk between the toes and drawing the entire alphabet in the air, letter by letter. Repeat four times a day.
Half a squat
Leg extension avoiding the last 20 ° -40 ° of the movement
Prognosis and recovery time
Thanks to an adequate rehabilitative treatment and a little physical therapy, about 90% of the people who have suffered a rupture of the anterior cruciate ligament and 80% of those in which the lesion has affected the posterior cruciate recover completely the efficiency. lost joint. Almost all of the medial collateral distortions and most lateral collateral lesions have an excellent prognosis.
Generally the first degree or second degree minor knee distortions affecting the collateral ligaments can heal in 2-4 weeks, while for more severe injuries it can take up to 4-12 months of rehabilitation. After a sprained knee it is important not to force the return to competitive activity or training as this could favor new distorting episodes. Complications such as knee osteoarthritis can occur after many years (15-25) in the case of major lesions of the anterior or posterior cruciate treated with a conservative method.
