What are the implications of a superior articular surface tear of the medial meniscus, an undersurface tear of the rear of the lateral meniscus, an Anterior Cruciate Ligament (ACL) sprain with interstitial tear, a meniscocapsular tear of the medial meniscus, and an oblique tear of the lateral meniscus in the left knee?

From the Guidelines

The most effective treatment approach for the described knee injuries, including tears of both the medial and lateral menisci and an ACL sprain with interstitial tear, is a multidisciplinary rehabilitation program that combines physical therapy, strength and motor control training, and gradual progression to sports-specific activities, as recommended by the most recent and highest quality study 1.

The knee injuries described involve multiple structures, including tears of both the medial and lateral menisci, as well as an ACL sprain with interstitial tear. Treatment typically begins with conservative management, including:

• Rest, ice, compression, and elevation (RICE protocol)
• Physical therapy to restore range of motion, strengthen surrounding muscles, and improve stability
• Anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) to manage pain and swelling
• A knee brace to provide support during recovery

Depending on the severity of the tears and the patient's activity level, surgical intervention might be required, particularly for the meniscal tears. Arthroscopic surgery allows for repair or partial removal of damaged meniscal tissue and reconstruction of the ACL if necessary. Recovery from surgery typically takes 6-12 months with dedicated rehabilitation, as outlined in the Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction 1.

These injuries affect knee stability because the menisci act as shock absorbers between the femur and tibia, while the ACL prevents forward sliding of the tibia and provides rotational stability. Without proper treatment, these injuries can lead to chronic instability and early onset osteoarthritis. The rehabilitation protocol should be based on progression criteria, with time since surgery considered necessary but not sufficient for progression, unless coupled with objective physical and psychological criteria, as recommended by the Aspetar guideline 1.

The goal of rehabilitation is to return the patient to their pre-injury level of activity, while minimizing the risk of reinjury, and this can be achieved through a well-structured rehabilitation program that includes strength and motor control training, as well as gradual progression to sports-specific activities, as supported by the evidence 1.

In terms of specific rehabilitation strategies, exercise interventions should be considered the foundation of ACLR rehabilitation, and should include a combination of strength and motor control training, as well as sports-specific activities, as recommended by the Aspetar guideline 1. The rehabilitation protocol should also include a transition phase from sports participation to sports performance, with progressive and controlled exposure to the athlete's sport, to ensure a safe and successful return to competition.

Overall, the most effective treatment approach for the described knee injuries is a multidisciplinary rehabilitation program that combines physical therapy, strength and motor control training, and gradual progression to sports-specific activities, as recommended by the most recent and highest quality study 1.

From the Research

Implications of Knee Injuries

The implications of a superior articular surface tear of the medial meniscus, an undersurface tear of the rear of the lateral meniscus, an Anterior Cruciate Ligament (ACL) sprain with interstitial tear, a meniscocapsular tear of the medial meniscus, and an oblique tear of the lateral meniscus in the left knee can be significant.

• Knee stability and movement coordination impairments can occur as a result of these injuries 2, 3.
• A thorough history and physical examination of the knee is necessary to facilitate accurate diagnosis of ligament injury 4.
• Advanced imaging can be used to augment a history and examination when necessary, but should not replace a thorough history and physical examination 4.
• Physical therapists can play a crucial role in improving knee stability and movement coordination impairments during nonoperative and operative management 2, 3.
• Clinical practice guidelines, such as the revised guidelines on knee ligament sprains, can help to reduce unwarranted variation in clinical physical therapy practice and support evidence-informed practice 2, 3.

Diagnosis and Treatment

• The diagnosis of knee ligament injuries requires a thorough history and physical examination, as well as the use of examination techniques that were developed before advanced imaging 4.
• The treatment of knee ligament injuries can involve nonoperative and operative management, and physical therapists can play a crucial role in improving knee stability and movement coordination impairments during these management strategies 2, 3.
• The implementation of clinical practice guidelines can help to ensure that patients receive the best care to optimize their recovery 2, 3.

Return to Activities

• The determination of when patients are ready to return to activities after injury is an important consideration in the management of knee ligament injuries 2.
• Clinical practice guidelines can provide updated recommendations based on best practices for evaluating, diagnosing, and treating knee ligament injuries, as well as determining when patients are ready to return to activities 2, 3.