KNEE LIGAMENT INJURIES

Knee ligament injuries are mostly ACL, MCL, LCL, or PCL tears. Physio treatment depends on which ligament, grade of tear, and whether you’re having surgery. But the principles are the same: control swelling, restore motion, rebuild strength, then return to function.

1. *Figure out what’s torn and how bad*

Physios check:

- *Mechanism*: Twisting with foot planted = ACL. Direct blow to outside of knee = MCL. Hyperextension = PCL. 

- *Instability test*: Lachman, anterior drawer for ACL. Valgus stress for MCL. 

- *Associated injuries*: Meniscus and cartilage often go with ligament tears. 

- *Grade*: Grade 1 = stretch, Grade 2 = partial tear, Grade 3 = full tear. Grade 1-2 MCLs often heal without surgery. ACLs rarely heal on their own.

2. *Acute phase: 0-2 weeks*

Goal is to reduce swelling, regain motion, and avoid muscle wasting.

- *Swelling control*: Compression, elevation, gentle range of motion. Stiffness now leads to long-term problems.

- *Weight bearing*: MCL/LCL grade 1-2 = partial to full weight bearing as tolerated. ACL = usually weight bearing with brace. 

- *Quad activation*: Straight leg raises, quad sets. VMO shuts down fast after knee injury - you have to wake it up.

- *Bracing*: Often used early for ACL and grade 2-3 MCL/LCL to protect during healing.

3. *Strength and stability phase*

This is where you rebuild what keeps the knee stable.

- *Quad strengthening*: Spanish squats, terminal knee extensions, leg press. Quad strength is the biggest predictor of good outcomes after ACL injury.

- *Hamstring and glute work*: Hip hinges, bridges, single-leg RDLs. Strong posterior chain offloads the ACL.

- *Proprioception*: Single-leg balance, wobble board, eyes closed. Ligaments have mechanoreceptors - you need to retrain them.

- *Range of motion*: Full extension is critical. Loss of extension leads to limping and poor mechanics.

4. *Functional and return-to-sport phase*

Start once you have full ROM, no swelling, and good quad strength.

- *Plyometrics*: Hops, bounds, landing mechanics. Focus on soft landings and knee alignment.

- *Agility drills*: Cutting, pivoting, deceleration. Teach the knee to handle rotational loads.

- *Sport-specific drills*: Running, cutting, jumping at increasing intensity.

- *Criteria-based progression*: Don’t go by time alone. You need 80-90% quad strength vs other leg, hop test symmetry, and no swelling.

5. *Surgical vs non-surgical*

- *ACL*: Young, active, unstable knee = usually surgery. Older, low demand, stable knee = conservative rehab works. Rehab is 9-12 months either way.

- *MCL*: Grade 1-2 heal well with bracing + rehab in 4-8 weeks. Grade 3 often needs surgery if combined with ACL.

- *PCL*: Often managed conservatively unless severe. Posterior sag needs to be managed with quad strengthening.

- *LCL*: Less common, often with other injuries. Rehab similar to MCL.

What separates good outcomes from bad

*Quad strength and landing mechanics*. If you return to sport with weak quads and poor landing control, you’ll re-tear. Most re-tears happen because people skip the last 2 months of rehab.

Timeline

- MCL grade 1-2: 4-6 weeks

- ACL conservative: 3-6 months

- ACL post-surgery: 9-12 months

- Return to pivoting sports only when hop tests are symmetric and you feel confident

Knee ligament rehab is long because ligaments heal slow and you need strength + neuromuscular control to protect them.

Which ligament are you dealing with, and is surgery on the table? That changes the plan a lot.

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