Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain

Publication Date: October 31, 2017

Summary of Recommendations

DIAGNOSIS/CLASSIFICATION

Physical therapists should diagnose the International Classification of Diseases (ICD) categories of Sprain and strain involving collateral ligament of knee, Sprain and strain involving cruciate ligament of knee, and Injury to multiple structures of knee, and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based categories of knee instability (b7150 Stability of a single joint) and movement coordination impairments (b7601 Control of complex voluntary movements), using the following history and physical examination findings: mechanism of injury, passive knee laxity, joint pain, joint effusion, and movement coordination impairments. (A)
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DIFFERENTIAL DIAGNOSIS

The clinician should suspect diagnostic classifications associated with serious pathological conditions when the individual’s reported activity limitations and impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline, or when the individual’s symptoms are not resolving with intervention aimed at normalization of the individual’s impairments of body function. (B)
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EXAMINATION – OUTCOME MEASURES: ACTIVITY LIMITATIONS AND SELF-REPORTED MEASURES

Clinicians should use the International Knee Documentation Committee 2000 Subjective Knee Evaluation Form (IKDC 2000) or Knee injury and Osteoarthritis Outcome Score (KOOS), and may use the Lysholm scale, as validated patient-reported outcome measures to assess knee symptoms and function, and should use the Tegner activity scale or Marx Activity Rating Scale to assess activity level, before and after interventions intended to alleviate the physical impairments, activity limitations, and participation restrictions associated with knee ligament sprain. Clinicians may use the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) instrument as a validated patient-reported outcome measure to assess psychological factors that may hinder return to sports before and after interventions intended to alleviate fear of reinjury associated with knee ligament sprain. (B)
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EXAMINATION – PHYSICAL PERFORMANCE MEASURES

Clinicians should administer appropriate clinical or field tests, such as single-legged hop tests (eg, single hop for distance, crossover hop for distance, triple hop for distance, and 6-meter timed hop), that can identify a patient’s baseline status relative to pain, function, and disability; detect side-to-side asymmetries; assess global knee function; determine a patient’s readiness to return to activities; and monitor changes in the patient’s status throughout the course of treatment. (B)
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EXAMINATION – PHYSICAL IMPAIRMENT MEASURES

When evaluating a patient with ligament sprain over an episode of care, clinicians should use assessments of impairment of body structure and function, including measures of knee laxity/stability, lower-limb movement coordination, thigh muscle strength, knee effusion, and knee joint range of motion. (B)
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INTERVENTIONS – CONTINUOUS PASSIVE MOTION

Clinicians may use continuous passive motion in the immediate postoperative period to decrease postoperative pain after anterior cruciate ligament (ACL) reconstruction. (C)
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INTERVENTIONS – EARLY WEIGHT BEARING

Clinicians may implement early weight bearing as tolerated (within 1 week after surgery) for patients after ACL reconstruction. (C)
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INTERVENTIONS – KNEE BRACING

Clinicians may use functional knee bracing in patients with ACL deficiency. (C)
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Clinicians should elicit and document patient preferences in the decision to use functional knee bracing following ACL reconstruction, as evidence exists for and against its use. (D)
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Clinicians may use appropriate knee bracing for patients with acute posterior cruciate ligament (PCL) injuries, severe medial collateral ligament (MCL) injuries, or posterolateral corner (PLC) injuries. (F)
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INTERVENTIONS – IMMEDIATE VERSUS DELAYED MOBILIZATION

Clinicians should use immediate mobilization (within 1 week) after ACL reconstruction to increase joint range of motion, reduce joint pain, and reduce the risk of adverse responses of surrounding soft tissue structures, such as those associated with knee extension range-of-motion loss. (B)
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INTERVENTIONS – CRYOTHERAPY

Clinicians should use cryotherapy immediately after ACL reconstruction to reduce postoperative knee pain. (B)
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INTERVENTIONS – SUPERVISED REHABILITATION

Clinicians should use exercises as part of the in-clinic supervised rehabilitation program after ACL reconstruction and should provide and supervise the progression of a home-based exercise program, providing education to ensure independent performance. (B)
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INTERVENTIONS – THERAPEUTIC EXERCISES

Weight-bearing and non–weight-bearing concentric and eccentric exercises should be implemented within 4 to 6 weeks, 2 to 3 times per week for 6 to 10 months, to increase thigh muscle strength and functional performance after ACL reconstruction. (A)
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INTERVENTIONS – NEUROMUSCULAR ELECTRICAL STIMULATION

Neuromuscular electrical stimulation should be used for 6 to 8 weeks to augment muscle strengthening exercises in patients after ACL reconstruction to increase quadriceps muscle strength and enhance short-term functional outcomes. (A)
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INTERVENTIONS – NEUROMUSCULAR RE-EDUCATION

Neuromuscular re-education training should be incorporated with muscle strengthening exercises in patients with knee stability and movement coordination impairments. (A)
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Recommendation Grading

Disclaimer

Overview

Title

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain

Authoring Organization

Publication Month/Year

October 31, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Review recent peer-reviewed literature and make recommendations related to knee ligament sprain.

Target Patient Population

Patients older than 12 years of age experiencing knee pain

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospice, Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Physical therapist, occupational therapist, chiropractor, athletics coaching, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Rehabilitation, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D007718 - Knee Injuries, D007719 - Knee Joint, D017888 - Medial Collateral Ligament, Knee, D020370 - Osteoarthritis, Knee

Keywords

knee stability, knee ligament sprain, knee pain