What is the treatment for a lateral knee adduction lock injury?

Treatment for Lateral Knee Adduction Lock Injury

Functional support combined with early exercise therapy is the preferred treatment for lateral knee adduction lock injuries, as this approach provides better outcomes than immobilization alone. 1

Initial Management

• Apply a short period (<10 days) of immobilization with a rigid support to decrease pain and edema and improve functional outcome 1
• Use functional supports (ankle brace or tape) that allow loading of damaged tissues in a protected manner while providing stability 1
• NSAIDs may be used for pain management in the short term (<14 days), though be aware they may potentially delay the natural healing process 1
• Paracetamol (acetaminophen) is equally effective as NSAIDs for pain, swelling, and range of motion with fewer side effects 1
• Avoid prolonged use of RICE (Rest, Ice, Compression, Elevation) alone as there is no evidence that it positively influences pain, swelling, or function 1

Rehabilitation Protocol

• Begin exercise therapy early as it has established efficacy in reducing recurrent injuries and functional instability 1
• Exercise programs should focus on neuromuscular and proprioceptive training 1, 2
• Use functional support for 4-6 weeks, with ankle braces showing greater effects than other types of functional support 1
• Manual joint mobilization combined with exercise therapy provides better outcomes than exercise therapy alone 1
• Avoid prolonged immobilization (>4 weeks) as it results in less optimal outcomes compared to functional support and exercise strategies 1

Advanced Treatment Options

• For most patients, functional treatment is preferred over surgical intervention 1
• Surgery may be considered for patients with chronic instability who have not responded to comprehensive exercise-based physiotherapy 1
• Surgical treatment may be superior at decreasing the prevalence of recurrent injuries, which is important as recurrent injuries increase the risk for subsequent development of osteoarthritis 1
• However, 60-70% of individuals respond well to non-surgical treatment, making surgery unnecessary for many patients 1
• Be aware that surgical treatment carries risks of longer recovery times, higher incidences of ankle stiffness, impaired mobility, and other complications 1

Return to Activities

• Functional treatment allows for quicker return to activities compared to immobilization 2
• Continue functional support during return to activities to provide stability and prevent reinjury 1, 2
• Implement neuromuscular training as it has shown significant preventive effects for recurrent injuries 2
• Be aware that reflex activity and motor function may be impaired following ice treatment, making patients more susceptible to injury for up to 30 minutes following treatment 3

Common Pitfalls and Caveats

• Avoid relying solely on RICE therapy, as evidence for its efficacy is limited 1
• Do not use compression stockings beyond the acute phase as they are not helpful in treatment 1
• Avoid continuous cryotherapy; instead, use repeated applications of 10 minutes to be most effective and avoid side effects 3
• Be cautious with early return to activities after ice application due to temporarily impaired motor function 3
• Do not assume all patients require surgical intervention, as many respond well to conservative treatment 1