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Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
[Medial collateral ligament bracing]
Maiti Münchgesang1, Daniel Günther2
1Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
Objective:
Addressing all injured structures and medial stabilization against both valgus stress and rotation.
Indications:
Acute, isolated medial collateral ligament (MCL) rupture grade III (especially distal and midsubstance rupture) and combined injuries/multiligamentary injury.
Contraindications:
Contraindications are chronic medial instability or rotational instability with indication for medial reconstruction as well as intolerance/allergy to material or other injuries requiring soft tissue consolidation/other operations (open wounds in the surgical area, fracture especially in the area of fixation). Relative contraindications are open growth plates.
Surgical Technique:
Recommendation for combination of arthroscopy and (mini) open procedure with refixation of superficial MCL (sMCL), if necessary deep MCL (dMCL) and posterior oblique ligament (POL), using suture anchors in anatomical position and under X‑ray control. Additional brace augmentation of the sMCL using tape.
Postoperative Management:
Weeks 1-6 partial weight bearing with 20 kg on crutches. Regardless of the leg axis, the range of motion is gradually increased every 2 weeks in a stabilizing hard-frame orthosis (extension/flexion): week 1-2: 0-20-60°, week 3-4: 0-10-90°, week 5-6: 0-0-90°, From the 7th week onwards, free range of motion, training off orthosis.
