Background: Knee dislocation is a traumatic but relatively rare injury that generally results in damage to multiple major stabilizing ligaments of the knee and, at times, vascular and neural compromise. Likewise, a rupture of the patellar tendon is extremely debilitating and rare. When sustained collectively these injuries can lead to difficulty in not only surgical intervention but also the rehabilitation processes. These injuries cause major impairments that must be addressed in a somewhat sequential manner to limit the development of long term difficulties and improve the prognosis for patients. The purpose of this case is to demonstrate the post-surgical physical therapy management of one individual with this injury.
Case presentation: The patient was a 42-year-old male who presented post-operatively following right knee dislocation and patellar ligament disruption without vascular or neural disruption. Following surgical repair of the medial collateral ligament and patellar ligament, the patient began physical therapy. The patient’s deficits included decreased range of motion, mobility, and strength of his right lower extremity. Therapeutic exercise, neuromuscular reeducation, gait training and modalities were provided to address the patient’s impairments and functional limitations.
Discussion: This case study follows the patient’s first 10 weeks of rehabilitation following surgery in an outpatient setting. The patient demonstrated rapid recovery with minimal to no pain and achieved all goals set for him in that time frame. He improved his functional ability through increased muscular strength and endurance, improved gait mechanics and balance, improved knee flexion range of motion by 50 degrees and increased Lower Extremity Functional Scale score by 28 points.
Conclusion: Overall, a physical therapy approach for this rare injury involving a slow increase in range of motion and gradual introduction of resistance exercise, balance, and gait training, improved the patient’s impairments and functional limitations.
Keywords: Multi-ligamentous Knee Injury, Patellar Ligament Disruption, Knee Dislocation, Therapeutic Exercise