Ligament injury

Question 1

Ankle ligament injuries

Answer 1

Lateral ligament sprain most common
Ottowa rules help decide who needs an x-ray:
1. Pain in malleolar zone and any of: tenderness over the posterior edge or tip of lateral malleolus; tenderness over the posterior edge or tip of medial malleolus, inability to weight bear immediately after injury or now
2. Pain in midfoot zone and any of: tenderness over navicular bone, tenderness of base of 5th metatarsal, inability to weight bear immediately after and now

Question 2

Ankle and knee ligament injuries - generic management

Answer 2

Apply ice pack for 20 mins
Crutches, analgesia and advice
NSAIDs
RICE (rest, ice 20 mins 4 times a day, compression elesatic bandage, elevation for 24 hours)
Then mobilise and weight bear as able
Try to fully weight bear on it for - 2 minutes twice a day for a month
Physio if not better in 1-2 weeks

Question 3

Knee ligament injuries

Answer 3

Ottowa rules help decide who needs a knee x-ray: age > 55; inability to weight bear both immediately after injury and now, isolated patella tenderness, head of fibula tenderness, inability to flex knee to 90

Knee exam may be difficult due to swelling - return in 1 week

Question 4

Grade 1 knee ligament injury

Answer 4

Ligament stretch with microscopic tearing
Knee stable on clinical testing
Elastic or wool & crepe bandage (for 2 weeks)
Heals in 2-4 weeks

Question 5

Grade 2 knee ligament injury

Answer 5

Ligament stretch with partial tearing
Laxity but definite end point
Knee brace (for 4 weeks or until no laxity on examination)
Heals in 4-12 weeks

Question 6

Grade 3 knee ligament injury

Answer 6

Complete rupture of ligament
Joints opens > 1cm
MCL / LCL - knee brace (for 6-12 weeks or until no laxity)
ACL / PCL - cast and surgical reconstruction

Question 7

Meniscus

Answer 7

Knee gives way, clicks and locks

Arthroscopic repair if locked knee or knee is no better in 2 weeks