Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :

How to wear this knee brace? - - Posted by LostBok (LostBok), 7 March 2003

Bit of an essay / background / life story - but would appreciate some advice if people can be bothered to read / skim through it all. If you're in a rush - just the last paragraph has the important stuff.



About three years ago I managed to do a reasonably serious ammount of damage to my knee: the joint "jumped" - my right knee basically popped out of joint and back in again, but at the end of I had a torn MCL, ruptured ACL, ruptured PCL, torn meniscus and some cartilage damage too.

The long and the short of it is that they were somehow able to repair the MCL, no permanent damage to the one of the cruciates and the other one had to be "trimmed" because had become trapped in the joint.

So 1 op (keyhole), 6 weeks immobilised (in fibreglass cast) and a whole load of gym work and I was actually back to playing hockey and squash in four months!

The knee is reasonably stable, but it had "wobbled" a few times while playing sports - especially more recently, now that I'm pushing myself competitively again. I think the cruciates are fine, but their is definitely too much movement in the MCL.

I have purchased a McDavid knee brace (http://bracesupport.com/mcdavid/kneeguard.htm) and this looks like it might help for when I'm playing sport, however: given that my only apparent remaining knee problems are with the MCL, should I be wearing the hinge on the outside of the knee as recommended in the instructions or on the inside of the knee where it would presumably be able to support the knee better?

Any suggestions/general advice appreciated!

Chris (aka LostBok)
Posted by LostBok (LostBok), 7 March 2003

Is this the correct area for such a question?
Posted by Netty (Netty), 11 March 2003

Hi, I wear a hinged Donjoy brace on the knee Ive had 3 recons on but I recently damaged the MCL on my good knee. It would make sense to wear the hinge on the inside (medial ) side but Im not sure of your brace as mine has the hinges both sides. I guess it wouldnt make much difference as long as the hinge keeps your lower leg from moving out of position. Usually if the MCL is gone your leg will move out to the lateral side so if it was brace on the lateral side then it should stop the movement. Maybe you should try a double hinged brace. Hope this helps, Netty
Posted by ATsoccergirl (ATsoccergirl), 25 March 2003

The type of brace you described is a prevenative counter-force brace.  I often see these on football players.  It is designed to protect aganst MCL injuries.  The hinge goes on the lateral aspect of the knee.  When an athlete is hit from the lateral side, the hinge is designed to transmit the forces from the blow to the quads and gastroc muscles, preventing a medial joint opening which may damage the MCL.  These are not designed for support of an unstable knee.  You would be better off with a more supportive brace with bilateral hinges.  Try the Donjoy Playmaker brace or I believe McDavid has a bilateral hinge brace.  

You mentioned that you had both a torn ACL and PCL, yet you never mention any reconstructive surgery.  
Posted by LostBok (LostBok), 25 March 2003

Ruptured PCL and ACL, not torn. Apparently one of them (can't remember which off the top of my head) became trapped in the joint when my knee popped back into place and around a quarter of it had to be "trimmed" to free it from the knee joint. Aside from that, no permanent damaged to the cruciates.

The MCL was the worst off and it there that I still get problems relating to instability - but probably not helped by too much movement in the ACL and PCL.

When I say "instability" I mean I can play hockey and squash without any problems at all most of the time, but I have had a few occurences (over nearly three years now) where the joint has "wobbled" - it gives way toward the lateral side. I've been able to get my other leg around and level myself out / just throw myself on the ground to straighten it out the few times that it has happened, but it's not a pleasant experience and the thought of spending 6 weeks with my leg immobilised again isn't appealing.

Is one of those double hinge braces really going to make that much of a difference?

thanks,
  Chris
Posted by Netty (Netty), 25 March 2003

Hi, me again,
My knee is unstable and as I said before, I wear a brace that is hinged on both sides to play sport. This means I have no sideways movement but I can have full range of forward and back movement. Its very unrestrictive and you can see what sort of brace I wear in the Donjoy.com site, its called a 4titude. I liked the look of their Legend brace but my orthotist recommended the 4titude. If you hold your knee from behind the joint with one hand and with the other hand, place it on the inside of your ankle and gently push it towards the lateral side you should see if you have any medial movement. Hard to explain but easy to do.
Medial ligaments can heal themselves but rarely heal tight. I have had mine pulled tighter and pinned twice now but its still very loose, it goes about half an inch out toward the lateral side if I do the above test.
Anyway, I play sports again with 100% confidence that my leg wont get any sideways movement. Netty
Posted by LostBok (LostBok), 25 March 2003

I know the test - basically a self-administered version of the test that physio's / orthopaedic surgeons do to test lateral / medial ligaments.

I can't check right now (in the office) I'll check later - this injury is over two and a half years old.

The medial ligament (and the whole knee with it) were imobilised for nearly six weeks after the initial op - so that the medial could heal up properly... top of my thigh to my ankle in fibre-glass.... nice  

laters,
  Chris
Posted by ATsoccergirl (ATsoccergirl), 25 March 2003

The counterforce brace will not provide any support to the MCL.  If you really don't want a bilateral hinge brace, you could try an OA unloader.  This kind of brace is built very similar to the CF brace, except it has a special hinge that allows for the joint to be placed in a position of varus stress.  It also has a dynamic strap that is used to further keep the knee in a varus alignment.  I have torn my MCL twice, the second time I had over 10mm of joint opening.  It has been reduced to close 6mm.  I play soccer with a Townsend Premier CI brace (I have a reconstructed ACL and PLC).  Due to the MCL instability I have, my ortho added a dynamic strap to the brace.  He routinely uses unloader braces on MCL injuries and has had great results with them.  The weblink shows a brace similar to the one I used.
http://www.g2orthotics.com/Products/Details/?target=01-UNLXT


Posted by Netty (Netty), 14 May 2003

With the MCl, the ortho's seem to tel everyone that it will heal an tighten in time. I have found that it often heals loose. Ive had a procedure called a lateral loop done where they take about 4cms of the quad muscle and loop it around the lateral lig to try and strengthen it. I have since been told that this caused more problems than it cured. I havent heard anyone tell me if they have had a successful MCL surgery as yet.
Let me know if you find out how to heal an MCL. Netty
Posted by LostBok (LostBok), 14 May 2003

Mine has healed and tightened reasonably well.

I was told my the ortho that only one of the Cruciates would have any permanent damage, but my leg does still sometimes "wobble" - especially if I'm stepping up the ammount of hockey / squash I'm playing when I've been out for a few weeks. This time I stopped using the brace a week or so after I regarded myself as being "fit".

Let's face it, if I'm playing hockey and squash on myu knee then it can't be in too bad shape anyway

rgds,
  Chris

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

Advertisement