Introduction
The MCL, LCL & PCL Masterclass, taught by Randall Cooper and Julian Feller, provides acomplete overview of the assessment and management of injuries to these ligaments in theknee. This executive summary provides clinically relevant, actionable information that may beuseful to health professionals.
Part 1: Clinical Assessment
During the knee clinical examination, observe the knee generally first, then assess effusion, range of motion, special tests (e.g Lachman’s, Anterior Drawer, McMurray's & Pivot Shift Test), hip rotation, patella mobility/position, posterior lateral corner and a Beighton score screening for hyper mobility. Ensure the patient is relaxed, to aid clarity and ease of the exam.
- When examining ligaments such as the MCL or LCL, there are many methods to perform the test depending on the clinician’s hand size and experience level.
- To test the posterior lateral corner, have the knee slightly flexed and assess tibial internal and external rotation.
Part 2a - PCL Injury: Management Options
The mechanism of injury and history is important when diagnosing a PCL injury. Indications for surgery include significant PCL laxity or multi-ligament injury. The people who have had a PCL injury usually complain more of a ‘grumbling’ knee, recurrent effusion and difficulties with acceleration/deceleration.
- A grade 2 PCL laxity is when the tibia goes to the distal end of the femoral condyle. A grade 3 is if it goes further than that.
- Before performing the posterior drawer test, it’s important to have the tibia at a neutral position and to have the hamstrings relaxed.
- A modern PCL brace locks the knee into extension and is quite effective for allowing the PCL to heal in its physiological position.
Part 2b - PCL Injury: Rehabilitation Considerations
The fundamentals of ACL and PCL rehab are quite similar and it is important to try to maintain the person’s fitness. The focus of the rehab should be placed on restoring the affected muscle groups and then a gradual exposure back to the previous activity level.
- In the first 3 months since surgery, be cautious with open-chain hamstring exercises.
- Appropriate early hamstring exercises include more hip-dominant movements (e.g Romanian deadlift).
- Post-operatively, regaining quad strength and activation should be the main focus.
Masterclass Preview
Take a sneak peak of Julian discussing non-operative management of PCL injuries.
Part 3 - MCL Injuries
MCL injuries should be graded in laxity, especially into extension and the approach should be individualised. There are some bracing options that could also be considered for patient comfort and healing.
- For an isolated MCL injury, a period in a hinge knee brace locked from 30-90 deg is appropriate with a graded strengthening into extension.
- If the MCL is lax in both flexion and extension, a surgical opinion is warranted.
Part 4: Rehabilitation
The LCL is closely situated with the biceps femoris insertion, therefore injury can happen concurrently. The considerations with LCL rehab are to assess for potential Segond fracture, common peroneal nerve palsy/irritation and persistent lateral swelling.
- When introducing abduction/adduction exercises, place the theraband around the knee to reduce lever arm.
