Comprehensive rehabilitation for injuries to the medial collateral ligament of the knee in skiers and snowkiters

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Abstract

BACKGROUND: The main function of the medial collateral ligament is static stabilization when the tibia is deviated outward. Medial collateral ligament damage may result from the application of a sharp force to the tibia and knee joint in a valgus position, often leading to knee instability, recurrent synovitis and posttraumatic osteoarthritis. This often results in the development of functional disorders that sharply limit the motor abilities of patients, thereby affecting the performance (support ability) of the injured limb.

AIM: The study aimed to conduct a comparative analysis of the efficiency of various current rehabilitation techniques providing a more patient-oriented approach in the conservative treatment of various degrees of medial collateral ligament injuries based on the assessment of the capabilities of magnetic resonance imaging in 38 patients.

MATERIALS AND METHODS: Thirty-eight patients (27 men and 11 women, 71.05% and 28.95%, respectively) with partial medial collateral ligament injuries were followed up. The mean age was 28.5 years (19–38 years). All subjects were involved in skiing and snowkiting in the “alpine skiing” discipline. The diagnosis was made based on clinical examination, patient’s complaints, and magnetic resonance imaging (MRI) of the knee joint. The examination was performed on a Vestra-2 magnetic resonance tomograph with a superconducting magnet and a magnetic field induction of 0.5 Tesla. Optimal for knee joint examination was a quadrature Surf-76 receiving and transmitting coil, which allowed the selection of a small field of view without artifacts or spatial distortion and increased the signal/noise ratio. The knee joints were examined twice: on the day of admission (maximum 1.5 days after injury) and at the end of the week 6 of conservative treatment.

RESULTS: Using the rehabilitation treatment program proposed by the authors in patients with medial collateral ligament injuries, a decrease in the severity of clinical symptoms and an improvement of functional characteristics were observed. Inclusion of the kinesiotaping technique led to a reduction of the treatment recovery period.

CONCLUSIONS: Current noninvasive diagnostic techniques (in particular, MRI) for bone tissues, articular cartilages, and periarticular soft tissues allow to determine the degree of damage to anatomical structures, choose the optimal conservative treatment method , and set the duration and extent of artificial immobilization and the terms of the onset of rehabilitation procedures for patients with partial injuries of the medial collateral ligaments. The results of the proposed rehabilitation treatment program for injuries of the medial knee ligament include a reduction of pain, synovitis and limping, and an improvement of muscle strength and elasticity and knee stability.

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About the authors

Vitaly Yu. Levkov

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: levkovv@ya.ru
ORCID iD: 0000-0002-4104-2886

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Mariya S. Ikonnikova

N.I. Pirogov Russian National Research Medical University

Email: Vasya_ikonnikova@mail.ru
Russian Federation, 1, Ostrovityanova, Moscow, 117997

Larisa B. Andronova

N.I. Pirogov Russian National Research Medical University

Email: larisaandronova@mail.ru

MD, Cand. Sci. (Med.)

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Andrey N. Remizov

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology

Email: andrey.remizov@fccho-moscow.ru
ORCID iD: 0000-0003-1918-0841
Russian Federation, Moscow

Maxim V. Panyukov

N.I. Pirogov Russian National Research Medical University

Email: maxim287@mail.ru

MD, Cand. Sci. (Med.)

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Antonina V. Butorina

N.I. Pirogov Russian National Research Medical University

Email: avbutorina@gmail.com

MD, Doc. Sci. (Med.), Рrofessor

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Boris A. Polyaev

N.I. Pirogov Russian National Research Medical University

Email: polyaev@sportmed.ru

MD, Dr. Sci. (Med.), Рrofessor

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Andrey N. Lobov

N.I. Pirogov Russian National Research Medical University

Email: a_lobov54@mail.ru

MD, Dr. Sci. (Med.), Professor

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Valeriy P. Plotnikov

N.I. Pirogov Russian National Research Medical University

Email: pronator@mail.ru

MD, Dr. Sci. (Med.), Рrofessor

Russian Federation, 1, Ostrovityanova, Moscow, 117997

Aleksandra V. Platonova

Kite School Storm

Email: school@storm-kite.com
Russian Federation, Moscow

References

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Supplementary files

Supplementary Files
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1. Fig. 1. Snowkiting competitions.

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2. Fig. 2. Postoperative knee orthosis with a biomechanical joint.

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3. Fig. 3. Semirigid knee orthosis with spiral stiffeners.

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4. Fig. 4. Gravitrin-Freespine trainer.

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5. Fig. 5. Magnetic resonance imaging for injury to the medial collateral ligament: a, immediately after injury; b, at the end of week 6 of conservative treatment. Imaging of a subtotal injury (grade I) of the medial collateral ligament, STIR, and T1-weighted images are presented.

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6. Fig. 6. Partial rupture of the medial collateral ligament: a, after injury; b, after recovery.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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