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Medial Collateral and Lateral Collateral Ligament Injury Medication

  • Author: Adam B Agranoff, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Jul 20, 2015
 

Medication Summary

The goal of pharmacotherapy is to reduce morbidity.

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Nonsteroidal anti-inflammatory drugs

Class Summary

These have analgesic, anti-inflammatory, and antipyretic activity. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Ibuprin)

 

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Celecoxib (Celebrex)

 

Primarily inhibits COX-2. COX-2 is considered an inducible iso-enzyme; it is induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 iso-enzyme is not inhibited; thus, incidence of GI toxicity, such as endoscopic peptic ulcers, bleeding ulcers, perforations, and obstructions, may be decreased when compared with nonselective NSAIDs. Seek lowest dose for each patient.

Neutralizes circulating myelin antibodies through anti-idiotypic antibodies; down-regulates pro-inflammatory cytokines, including INF-gamma; blocks Fc receptors on macrophages; suppresses inducer T and B cells and augments suppressor T cells; blocks complement cascade; promotes remyelination; may increase CSF IgG (10%).

Has a sulfonamide chain and is primarily dependent on cytochrome P450 enzymes (a hepatic enzyme) for metabolism.

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Analgesics, miscellaneous

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or injuries.

Tramadol (Ultram)

 

Inhibits ascending pain pathways by binding to mu-opiate receptors in CNS, thus altering perception of and response to pain. Also inhibits re-uptake of norepinephrine and serotonin.

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Contributor Information and Disclosures
Author

Adam B Agranoff, MD Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital

Adam B Agranoff, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Robert J Kaplan, MD Staff Physician, Department of Rehabilitation Medicine, James E Van Zandt VA Medical Center

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References
  1. Fu FH, Harner CD, Johnson DL, et al. Biomechanics of knee ligaments: basic concepts and clinical application. Instr Course Lect. 1994. 43:137-48. [Medline].

  2. Swenson TM, Harner CD. Knee ligament and meniscal injuries. Current concepts. Orthop Clin North Am. 1995 Jul. 26(3):529-46. [Medline].

  3. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996. 783-812.

  4. Amiri S, Cooke D, Kim IY, et al. Mechanics of the passive knee joint. Part 2: interaction between the ligaments and the articular surfaces in guiding the joint motion. Proc Inst Mech Eng [H]. 2007 Nov. 221(8):821-32. [Medline].

  5. National Collegiate Athletic Association. NCAA Injury Surveillance System. 1999-2000. [Full Text].

  6. Yawn BP, Amadio P, Harmsen WS, et al. Isolated acute knee injuries in the general population. J Trauma. 2000 Apr. 48(4):716-23. [Medline].

  7. Quarles JD, Hosey RG. Medial and lateral collateral injuries: prognosis and treatment. Prim Care. 2004 Dec. 31(4):957-75, ix. [Medline].

  8. Dugan SA. Sports-related knee injuries in female athletes: what gives?. Am J Phys Med Rehabil. 2005 Feb. 84(2):122-30. [Medline].

  9. El-Dieb A, Yu JS, Huang GS, et al. Pathologic conditions of the ligaments and tendons of the knee. Radiol Clin North Am. 2002 Sep. 40(5):1061-79. [Medline].

  10. Pimentel L. Orthopedic trauma: office management of major joint injury. Med Clin North Am. 2006 Mar. 90(2):355-82. [Medline].

  11. Strayer RJ, Lang ES. Evidence-based emergency medicine/systematic review abstract. Does this patient have a torn meniscus or ligament of the knee?. Ann Emerg Med. 2006 May. 47(5):499-501. [Medline].

  12. Crotty JM, Monu JU, Pope TL Jr. Magnetic resonance imaging of the musculoskeletal system. Part 4. The knee. Clin Orthop Relat Res. 1996 Sep. 288-303. [Medline].

  13. Beall DP, Googe JD, Moss JT, et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Radiol Clin North Am. 2007 Nov. 45(6):983-1002, vi. [Medline].

  14. Hastings DE. The non-operative management of collateral ligament injuries of the knee joint. Clin Orthop. 1980 Mar-Apr. (147):22-8. [Medline].

  15. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. 2007 Oct. 23(10):1066-72. [Medline].

  16. Wahl CJ, Nicandri G. Single-Achilles allograft posterior cruciate ligament and medial collateral ligament reconstruction: a technique to avoid osseous tunnel intersection, improve construct stiffness, and save on allograft utilization. Arthroscopy. 2008 Apr. 24(4):486-9. [Medline].

  17. Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res. 2012 Mar. 470(3):798-805. [Medline]. [Full Text].

  18. Schein A, Matcuk G, Patel D, Gottsegen CJ, Hartshorn T, Forrester D, et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol. 2012 Dec. 19(6):489-98. [Medline].

  19. Atoun E, Debbi R, Lubovsky O, Weiler A, Debbi E, Rath E. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release. Arthrosc Tech. 2013 Feb. 2(1):e41-3. [Medline]. [Full Text].

  20. Medvecky MJ, Zazulak BT, Hewett TE. A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete. Sports Med. 2007. 37(2):169-87. [Medline].

  21. Yoshiya S, Kuroda R, Mizuno K, et al. Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med. 2005 Sep. 33(9):1380-5. [Medline].

  22. Dong J, Wang XF, Men X, et al. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy. 2015 Jun. 31 (6):1108-16. [Medline].

 
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The medial and lateral collateral ligaments of the knee. Courtesy of Randale Sechrest, MD, CEO, Medical Multimedia Group.
 
 
 
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