The patient with instability related to multiple ligament/capsule injuries is a great challenge for surgeon and therapist as outlined in a previous chapter. Certain combinations, such as ACL or PCL with posterolateral injury require surgical intervention, which make rehabilitation more difficult as the required early postoperative ROM limitations may provide a challenge to normalizing the ROM long term. Ambulatory abnormalities are often seen in these patients as they may have adopted a varus thrust gait preoperatively. A clinical pearl is to keep the knee flexed during gait by wearing a heel or heel lift under the involved extremity. In the clinic, patients may be instructed in an exaggerated form of this by walking in significant flexion (Groucho walk, as in Groucho Marx). Another activity to avoid is heavy closed-chain loading as the posterolateral corner and PCL both lead to posterior arthritic changes. Open-chain strengthening is often the modality of choice but should be limited in its ROM (typically 90 to 30 degrees) as we do not want to aggressively load the last 30 degrees of extension (thus minimizing loading to the posterolateral corner as well as minimizing possible patellofemoral reaction). Again, it is imperative for the therapist and surgeon to have strong communication and provide a unified standard of expectation. Unfortunately, some of these patients expect too much improvement and are not able to accept that there are limitations as to what level of success will be achieved following surgery and rehabilitation.
Was this article helpful?
Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.