Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain
Publication Date: October 31, 2017
Last Updated: March 14, 2022
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)
325320
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)
325320
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)
325320
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)
325320
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)
325320
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)
325320
INTERVENTIONS – EARLY WEIGHT BEARING
Clinicians may implement early weight bearing as tolerated (within 1 week after surgery) for patients after ACL reconstruction. (C)
325320
INTERVENTIONS – KNEE BRACING
Clinicians may use functional knee bracing in patients with ACL deficiency. (C)
325320
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)
325320
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)
325320
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)
325320
INTERVENTIONS – CRYOTHERAPY
Clinicians should use cryotherapy immediately after ACL reconstruction to reduce postoperative knee pain. (B)
325320
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)
325320
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)
325320
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)
325320
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)
325320
Recommendation Grading
Overview
Title
Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain
Authoring Organization
American Physical Therapy Association
Publication Month/Year
October 31, 2017
Last Updated Month/Year
August 3, 2023
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