Bakgrund: Behandlingen av Mediala collateral ligament (MCL) skador är debatterad. En skada på MCL kan leda till sämre medial stabilitet och nedsatt aktivitetsförmåga. Målet med den konservativa behandlingsformen är att minska svullnad och smärta för att på så vis få tillbaka full rörlighet och stabilitet. Behandlingen innebär ofta någon form av öppen eller låst ortos tillsammans med ett rehabiliteringsprogram. Syftet: Syftet med studien är att utifrån litteraturen analysera studiernas bevisvärde och beskriva konservativa behandlingsmetoder för MCL, med öppna och låsta ortoser tillsammans med träning. Metod: En litteraturstudie användes, då syftet var att göra en beskrivning av kunskapsläget. Artikelsökningen resulterade i 13 inkluderade studier. För att bestämma bevisvärde för studierna användes en granskningsmall av Carlsson och Eiman (2003) och Statens beredning för medicinsk utvärderings punkt om studiedesign. Resultat: Studierna fick bevisvärden från lågt - mycket lågt. Efter analys av de inkluderade studierna framkom att den mediala knästabiliteten uppvisade ett varierat resultat i båda grupperna med öppen och låst ortos. Dock återgick de flesta patienter till sin tidigare aktivitetsförmåga efter behandlingarnas slut. Slutsats: Av litteraturstudien kan inga slutsatser dras gällande i vilken utsträckning den mediala knästabiliteten och aktivitetsförmågan förändrats efter konservativ behandling med öppen respektive låst orts tillsammans med träning. Studiernas låga bevisvärde och varierade behandlingsmetoder inom låst respektive öppen ortos försvagar slutsatsen ytterligare.

The knee is the most complex joint in the human body. It consists of a system of muscle, bone, and ligaments that endures repetitive loading during daily and athletic activities. When this loading is excessive, damage  to the knee occurs leading to a decreased quality of life.The medial collateral ligament (MCL) is one of the 4 major ligaments known to be commonly injured in the knee. The risk of injury to the knee joint increases with the elderly and individuals who experience chronic dehydration. For this reason, the focus of this study is to compare different mechanical quantities that can be used to analyze damage to the MCL. In this study, a novel mechanical testing protocol is used to progressively induce damage in dehydrated rat MCLs by performing tensile tests. This involves stretching the ligaments along their longitudinal axes to consecutive and increasing displacements starting at a 0.4 mm displacement and in increments of 0.2 mm until complete failure occurs. The load and change in length that the ligament experiences are measured at each displacement. Three different methods were evaluated to determine subfailure and damage propagation in rat MCLs: changes in tangent stiffness and chord stiffness, and changes in the load value at the 0.4 mm displacement for each load-displacement curve. The findings of this study indicate that the tangent stiffness and load at the 0.4 mm displacement provide information of the early onset of damage propagation. The decrease in chord stiffness of the ligament does not indicate damage progression in the ligament, but rather is the sign of the imminent failure of the MCL.This study provides insightful data into understanding the subfailure damage in the MCL. / Master of Science

Bakgrund: Skada på det mediala kollateralligamentet (MCL) är en av de vanligast förekommande knäskadorna och drabbar främst yngre idrottande personer. En av fysioterapeutens roller i rehabiliteringen är att se till människans helhet där biomedicinska, psykiska och sociala aspekter ingår, detta för att patienten ska få ett bra omhändertagande. Syfte: Att undersöka hur fysioterapeuter beskriver sitt arbete med rehabilitering av patienter med MCL-skador. Metod: En kvalitativ intervjustudie med deskriptiv design utfördes. Data insamlad från sex intervjuer av fysioterapeuter bearbetades med hjälp av en induktiv ansats i en kvalitativ innehållsanalys. Ett ändamålsenligt bekvämlighetsurval användes vid valet av intervjupersoner. Resultat/slutsats: Studiens resultat mynnade ut i fyra kategorier med två underkategorier inom varje. Kategoriernas namn var ”Identifierar behov av och arbetar med att ge patienterna stöd”, ”Anpassar rehabilitering efter patientens träningsmöjligheter och olika aktiviteter”, ”Arbetar med att minska rädsla, oro och öka tillit till knät hos patienterna” och ”Arbetar med patienternas motivation”. Det visade sig i studiens resultat att hänsyn togs av intervjupersonerna till såväl biomedicinska som psykosociala faktorer i sitt arbete med denna patientgrupp. / Background: Injury to the Medial Collateral Ligament (MCL) are one of the most common knee injuries and mainly affect younger athletes. One of the physiotherapists' roles in rehabilitation is to look at the whole of the human being, which includes biomedical, psychological and social aspects, in order to ensure a good medical care. Purpose: To investigate how physiotherapists describe their work with rehabilitation of patients with MCL injuries. Method: The design of the study was a qualitative interview study, with an inductive approach. Data collected from six interviews of physiotherapists was analysed using a qualitative content analysis. An appropriate convenience sample was used in the selection of interviewees. Result / conclusion: The study's results consisted of four categories with two subcategories within each. The names of the categories were "Identifying need of and work with supporting biopsychosocial factors", "Adapting rehabilitation to the patient's possibilities regarding training and various activities", "Working with reducing fear, worry and increasing the patient’s confidence regarding their knees" and "Working with the patients' motivation". It was shown in the results that consideration was taken by the interviewees regarding the patient’s biomedical and psychosocial factors.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12919号 / 論医博第2094号 / 新制||医||1009(附属図書館) / 32129 / (主査)教授 戸口田 淳也, 教授 妻木 範行, 教授 安達 泰治 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DGAM

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INTRODUCTION. Frontal collisions have been observed to cause the severe injuries on heavy goods vehicle occupants, and the lower extremities have been frequently injured. Injuries of knee joints are rarely life threatening, however they tend to give long-term consequences. AIM. Evaluate non-lethal frontal impacts towards the knee joint of Total Human Model for Safety (THUMS) v4.0 using a cylindrical barrier. The main objectives are to 1) create local injury risk functions of the knee ligaments restraining frontal impacts, 2) simulate frontal impacts towards the knee joints of THUMS and3) prepare the Hybrid III (HIII)-model for corresponding frontal impacts conducted on THUMS. The intention is for future HIII-simulations to be cross-correlated with the responses from THUMS for the ability to estimate knee ligament strains by investigating impacts on HIII. METHODS. 1) Ligament risk curves of PCL, MCL and LCL were formulated by assembling mean strain threshold values and standard deviations from literature. Virtual values were generated from these pooled strain thresholds, creating the risk curves. 2) THUMS lower body was impacted by a cylindrical steel barrier at four different locations - middle of patella, middle of knee joint, upper tibia and below tibia tuberositas. Four impact velocities ranging from 8-14 km/h were used at each location, giving a total of 16 impacts. 3) The HIII-model was prepared by removing the upper body and inserting the cylindrical steel barrier into the model file. RESULTS. The strain threshold at 50% rupture risk for PCL resulted in 23.6±4.4%, 34.2±6.0% for MCL and 26.6±6.5% for LCL. The simulated THUMS PCL strains reached between 36%-58% for the highest velocity at the impact locations where tibia was involved. Both MCL and LCL gave an approximate 5% strain outcome. The resultant knee displacement for these impacts ranged between 22 mm - 32 mm. The knee displacements at the PCL strain threshold ranged between 14 mm - 16 mm. DISCUSSION and CONCLUSION. Most of the maximal PCL strains exceeded the PCL threshold with large margins. However, the knee displacement at the PCL strain threshold resulted in outcomes comparable to the thresholds used for HIIImodel. These results supported the obtained PCL threshold to be within a reasonable range.