ACL Taping (for stability?)

[MamaMaya]

I am a physiotherapist with an injury.

Typical history of ACL rupture, Allograft repair, med/let meniscectomy after re-injury(2 yrs later), then new med. meniscus tear (12 years later). Lachman's is good, but positive pivot-shift.

I want to learn how to tape my knee for stability in non-weightbearing, ie: in the pool or ocean. I get a fair amount of pain after taking my 4 year old into the waves, standing, moving around, with the weight of the water on my lower leg at various angles. I can feel the joint laxity in non-weightbearing. I don't think my brace will work in the water. Or do I have to tape the brace on?

tips??

[sharileedahl]

Taping to limit some rotation at the knee may help. Have tried this with a client that had significant OA in her knee and seemed to help...
Basically taped a figure-8 around the knee - one each way. (Starting medial thigh (i.e. just above the knee) - crossing knee joint at lateral joint line - behind knee to medial "calf" (i.e. just below the knee) - around front of tibia - back behind the knee back to starting point; then do the same thing the opposite way (i.e. start on lateral side of "thigh"))

We used a good quality vet wrap (stronger than coban (?brand name) made for humans). Even typical vet wrap found in pet stores / livestock supply stores would probably work well as it probably will stand up to the water better than coban made for humans.

Not sure if it will work as well in an non-weight bearing position as with swimming but seems to be somewhat helpful in weight-bearing. Worth a try??

[neurospast]

I do understand you want to stabilise your knee but as you feel it is not that stabile. Now taping is a good short term idea, but what about building up the tone and the muscle power around the knee in order to stabilise the knee? this would also help in none weight bearing situations.

[linbin]

hi guys
i wonder why relying more on taping,as there is no strong evidence to support its use for stability.in the acute stages,i agree with its use.as its found to enhance proprioception by cutaneous feedback,when the proprioceptive role of the joint structures are altered.
as suggested above motor control enhancement of the knee should be given priority .

[MamaMaya]

Of course I've been trying to strengthen the knee and work on balance. I had a large medial menicsus tear at the posterior horn which was limiting my rehab. It has since been cleaned up(but still no ACL), so i can start rehab again.

I hadn't looked into the literature to find out what was best evidence. That's why I was asking the forum. Thanks for your input.

And thanks for the ideas about proprioceptive input. I've been thinking along those lines myself, since I am generally hypermobile. I was also running into trouble with ADLs, being a mom of 2 small kids, no matter how much training I would do, something would always trip me up. Like when the wave takes my lower leg in one direction while I'm grabbing for my drowning 4 year old in the other direction. I guess in essence I'm saying that motor control training is effective for intended movement only, but doesn't protect against passive forces. How do you replace joint position sense when the ligament is slack and the mechanoreceptors aren't stimulated?

I suppose that now the meniscus tear is gone, I won't have flare-ups from non-weightbearing twists.

[alophysio]

Hi,

Firstly, there must be braces out there to help you in the water - i wouldn't think taping would help.

Secondly, it is a misconception that motor control training doesn't help in those situations. In fact, what is often the case is that the motor control retraining never gets progressed to that level of function. Your point is valid that you are missing vital ingredients to normal function. Having said that, it is not proprioception via mechanoreceptors that protects but anticipation of the forces. e.g. ankle balance exercises do not protect you because the injury occurs in less time than it takes for the reflex loop to occur.

Lastly, you are missing structures that are required for normal function. One study (Norwegian??) showed that 100% of women with ACL ruptures go on to have OA whether operated or not. Your knee will degrade. By all means do your best to minimise the impact but i think your best bet for your stated intention is to find a de-rotation brace that you can use in the water.

Good luck!

[Hessa]

here is a vedio showing how to tape your knee
YouTube - Anterior Cruciate Ligament Taping
good luck

[Canuck Physio]

Hmmm... those are pretty grim prospects being pointed out.

I wouldn't buy into it, not only do you have the advantage of being a physio, you sound young enough and motivated enough to manage the problem.

Use your critical reasoning skills to help guide your self-Rx.
If something causes problems/discomfort its your body telling you to take a step back, write up a management program and stick to it.
Begin with low intensity exercise. I would begin with a program that you complete every single day. Best in the morning to set the pace for the day ahead. Be concerned about functional ergonomics and muscle balance.
Add in strength exercises, higher the intensity the more infrequent the program need be. Again work on optimizing your 'new' biomechanics.
No grim outcomes here, only hard work and results.
Regards

[alophysio]

HI Canuck Physio.

I would agree with you in general. However the facts are still the facts...they still haven't solved the rotation riddle in the knee. It is this movement that is thought to cause the OA even in ACL reco'd knees.

As for the proprioception, what we are retraining is awareness and cues, especially visual, to anticipate changes in direction. We are also teaching co-contraction because when you take the eyes out of the equation, you begin to increase the amount of muscle activity to complete a balancing task. By putting all these strategies in place, you can certainly help.

But my concern is that the ocean has currents and once the surf breaks near you, those currents can be unpredictable. Add a 4 year old to the equation and you have a nice recipe for a sore knee.

This is a genuine question because i might be wrong in my assumption...what muscles control knee rotation through range (i know about popliteus but that is only in/near extension ROM)?

THanks

[linbin]

hi
i feel the mscles that can have a control on knee rotation through range will be medial and lateral hamstrings,tensior fascia lata and sartorius.anyone has any other suggestions.please project your ideas.it is interesting

[alophysio]

Hi Limbin,

I no doubt the muscles listed have an effect on rotation. But is rotation strength of the knee something we can train? Apart from general functional strength training for twisting in various positions, i can't think of how to train it.

My personal view has always been that the foot and ankle in conjunction with the hip and pelvis send forces through to the knee and it simply tries its best to transfer load efficiently through the joint.

I am open to other views though - i am by no means certain of my own position...