The newest techniques allow for the expeditious management of acute ligament injury for all joints. It has particular application around the knee and ankle.
Where there is an unstable joint, a minor surgical procedure can allow the insertion of an “Internal Brace”. This is a very small artificial device that is laid over the top of the existing ligament, mimicking its exact anatomy. It is a small operation and allows the patient to immediately commence rapid rehabilitation and physiotherapy. The ligament heals underneath this structure and the result is that the joint supported by this ligament is stable.
It is rare for Associate Professor Miniter to use external knee and ankle braces after this surgery. Partial weight bearing may be needed to allow the ligaments time to heal, for a short time. As soon as the small incisions are healed the patient is allowed to start hydrotherapy. This provides a great sense of progress to these patients who are otherwise often frustrated wearing knee braces, for instance, for many weeks.
The benefits of this technique are manifold:
Early rapid rehabilitation
Preservation of joint function and mobility
Early return to work.
Normal joint mechanics longer term
Avoidance of those feelings of insecurity that even minor instability can bring.
There are key structures around the knee. If these are unstable, the joint does not function normally. The medial ligament ( MCL ) is one such structure. The lateral ( LCL) is another.
Case study:
26 year old weekend warrior sustains an injury to the medial collateral ligament of the right knee. He is unable to weight bear. His GP orders an MRI that shows a high grade tear of the medial ligment near its insertion into the femur. The ACL intact. There are no major meniscal injuries.
He is seen by his physiotherapist who puts him in a knee brace.
When seen by his orthopaedic surgeon, the options are presented:
Either wear a knee brace for 6 weeks and lets see how the knee stability is at that time.
Or: we suggest the internal bracing technique mentioned above.
He chooses the operative management protocol and goes home same day. He is allowed immediate touch weight bearing and is to use crutches for 2 weeks.
The knee is now perfectly stable.
No brace is used. He can start driving in 2 to 3 weeks or less, in comparison to the use of a knee brace for at least 6 weeks.
On review at 6 weeks post surgery he has a perfectly stable knee and has been back to work for a month.