management

Last reviewed 01/2018

Summary points:

Partial tear - if there has been a partial tear then spontaneous healing will occur where the intact fibres will splint the torn ones. It is essential to prevent adhesions and so active exercises are prescribed from the start of rehabilitation. The knee is protected from rotation or angulation strain by the use of a heavily padded bandage or a posterior splint. Treatment includes rest, ice, compression, elevation (RICE), and non–weight-bearing restriction with the use of crutches. Hinged bracing also may be used.

Complete tear - considered in terms of:

• medial ligament tear (most common) - previously complete tears were treated operatively but currently are routinely treated nonoperatively. In the past, nonoperative treatment meant a long leg cast. Currently, bracing with a hinged knee orthosis is common. Crutches are generally necessary for 1-2 weeks.
• lateral ligament tear - complete tears generally involve a tear in the posterolateral capsular complex and may be treated with surgical intervention
• anterior cruciate ligament tear - acute surgical intervention is associated with poor results (in general, surgical intervention is delayed at least 3 weeks). Intra-articular reconstruction, which requires graft selection, has become the gold standard for anterior cruciate ligament reconstruction. Nonoperative treatment may be considered in less active athletes who may not be participating in any pivoting type of sports (eg, cycling, running) or elderly patients.
• posterior cruciate tear - surgical repair indicated if displaced tibial avulsion fracture