Can lax ligaments in the knees of individuals with hypermobile joints be treated?

Management of Lax Ligaments in Hypermobile Knees

Exercise therapy and functional support are the most effective treatments for lax ligaments in hypermobile knees, rather than surgical intervention which should be reserved only for cases that don't respond to conservative management. 1

First-Line Treatment Approach

• Low-resistance exercise therapy should be initiated as soon as possible to improve joint stability by increasing muscle tone around hypermobile joints 1
• Exercise therapy programs have established efficacy in reducing recurrent injuries and functional joint instability 2
• Physical therapy with myofascial release techniques is often necessary to facilitate participation in exercise programs for patients with hypermobility 1
• Manual joint mobilization combined with exercise therapy provides better outcomes than exercise therapy alone 2

Functional Support Options

• Functional supports in the form of braces or tape allow controlled loading of damaged tissues in a protected manner 2
• Treatment with proper ankle/knee support is more effective than less adequate support such as compression bandages 2
• Functional support combined with exercise therapy provides better outcomes compared to immobilization 2

Surgical Considerations

• Surgery should be delayed in favor of physical therapy and bracing due to decreased stabilization outcomes in hypermobile patients 1
• Surgical therapy is mainly reserved for patients who have chronic instability and who have not responded to comprehensive exercise-based physiotherapy 2
• There is limited evidence for longer recovery times, higher incidences of joint stiffness, impaired mobility, and complications in patients who received surgical treatment 2

Pain Management

• A pain management specialist is crucial for patients with chronic pain related to hypermobility 1
• Neuromodulators such as tricyclic antidepressants, SSRIs, SNRIs, pregabalin, and gabapentin should be considered for pain management 1
• Opioids should be avoided for chronic pain management in hypermobile patients 1

Special Considerations for Hypermobility Syndromes

• Patients with joint hypermobility syndrome or Ehlers-Danlos Syndrome hypermobile type require a more comprehensive approach 3
• Vitamin C supplementation may improve hypermobility as it is a cofactor for cross-linking of collagen fibrils 1
• Calcium and vitamin D supplementation along with low-impact weight-bearing exercise is recommended for bone health 2, 1

Monitoring and Follow-up

• For patients with hypermobility syndromes, cardiovascular monitoring with echocardiograms is recommended to evaluate for aortic root dilatation 2
• Progress is often slow and may be hampered by physical and emotional setbacks, requiring long-term management 4

Common Pitfalls to Avoid

• Prolonged immobilization (>10 days) results in less optimal outcomes compared to functional support and exercise strategies 2
• Treating all patients with surgical intervention would mean unnecessary exposure to invasive procedures for many patients who would respond well to conservative treatment 2
• Failing to recognize that hypermobility may be part of a broader connective tissue disorder requiring multisystem management 3, 5
• Prescribing opioids for chronic pain management, which should be avoided in hypermobile patients 1

By following these evidence-based approaches, most patients with lax ligaments in hypermobile knees can achieve significant improvement in stability and reduction in symptoms, though the process may require patience and consistent adherence to the treatment program.