How to manage a twisted knee without a fall during mobilization?

From the Guidelines

To manage a twisted knee without a fall during mobilization, immediately stop activity and apply the RICE protocol. This approach is based on the most recent and highest quality study available, which emphasizes the importance of prompt and accurate diagnosis to facilitate adequate management and prevent potential complications 1. The RICE protocol consists of:

• Resting the knee completely for 24-48 hours
• Icing the area for 15-20 minutes every 2-3 hours
• Compressing with an elastic bandage applied snugly but not tight enough to impair circulation
• Elevating the knee above heart level when possible

For pain management, over-the-counter medications such as acetaminophen (Tylenol) 500-1000mg every 6 hours (not exceeding 4000mg daily) or NSAIDs like ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours with food (maximum 3200mg daily) can be used 1. Gentle range-of-motion exercises can begin after 48-72 hours if pain allows. It is also recommended to use assistive devices like crutches or a knee brace for stability during recovery. If severe pain, significant swelling, inability to bear weight, or the knee feels unstable or locks are experienced, seeking medical attention immediately is crucial as these may indicate a more serious injury requiring professional evaluation 1. The RICE protocol and pain management work together to reduce inflammation and swelling, and manage discomfort during the healing process, with most minor knee twists improving within 1-2 weeks with proper self-care.

From the Research

Management of Twisted Knee without Fall during Mobilization

• The management of a twisted knee without a fall during mobilization depends on the underlying cause of the knee pain, which can be due to various conditions such as osteoarthritis (OA), patellofemoral pain, or meniscal tears 2.
• Meniscal tears can occur due to acute trauma, such as a twisting injury, and can be diagnosed using the McMurray test and joint line tenderness 2.
• Conservative management, including exercise therapy, is recommended for most meniscal tears, with surgery considered only for severe traumatic tears or degenerative tears with mechanical symptoms 2, 3.
• For patients with knee OA and meniscal tears, a standardized physical therapy intervention and home exercise program can be effective in managing symptoms and improving function 3.
• The management of knee ligament injuries, including anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries, requires a comprehensive approach, including surgical and non-surgical options, and rehabilitation programs 4.
• Rehabilitation and return to play guidelines are crucial for patients with meniscal injuries, with the goal of preserving the meniscus and preventing degenerative changes 5.
• Meniscal repair is now considered a viable and effective alternative to arthroscopic partial meniscectomy, especially in young and physically active patients 6.

Diagnostic Approaches

• The diagnosis of knee pain and meniscal tears can be made clinically, using tests such as the McMurray test and joint line tenderness 2.
• Imaging modalities, such as MRI, can be used to confirm the diagnosis and assess the extent of the injury 6.

Treatment Options

• Conservative management, including exercise therapy, is recommended for most meniscal tears and knee OA 2, 3.
• Surgical options, such as meniscal repair or arthroscopic partial meniscectomy, may be considered for severe or degenerative tears 2, 6.
• Rehabilitation programs, including physical therapy and home exercise programs, are essential for patients with knee injuries and meniscal tears 3, 5.