An Unhappy Triad is a combination injury to the knee joint in which the anterior cruciate ligament and the inner collateral ligament (“inner ligament”) are torn and the inner meniscus is also injured. This injury often occurs when the knee is twisted under pressure and in the X-leg position, such as when skiing, soccer or handball. In most cases, strong pain occurs immediately, the knee develops a swelling and becomes unstable. Usually an Unhappy Triad is treated surgically due to the severity of the injury and the expected instability of the joint. This is usually followed by rehabilitation measures with physiotherapy.
Physiotherapy in different stages of healing
Physiotherapy in an Unhappy Triad is based on the respective healing phase. In the early phase after surgery (or in the case of conservative treatment after the accident), the doctor usually prescribes partial weight bearing with forearm crutches (“crutches”). In addition, the patient wears an orthosis (“splint”) to limit flexion of the knee and stabilize it.
In this phase, tension exercises of the musculature are started and the knee is moved to the permitted extent with the support of the therapist. Walking and climbing stairs on crutches is also practiced. Manual lymphatic drainage can help to reduce swelling.
It is also possible to practice on a bicycle ergometer at a low level. After approx. 6 weeks, a gradual change from partial to full weight bearing is possible.
Depending on the extent of movement allowed, the flexion of the knee can be improved and the muscles surrounding the knee can be built up. Stretching improves and maintains the mobility of the structures. Now you can also carefully start training on equipment, for example on a leg press.
Exercises for coordination and balance are also very important in therapy. An improved gait pattern can be worked out together with the therapist. Approximately 8 weeks to 3 months after the operation, the load can be further increased.
The stability of the knee and the restoration of full mobility and coordination are the goals in this late phase of therapy. Depending on the findings, more dynamic exercises can be started, possibly adapted to your favorite sport. Nevertheless, the patient should refrain for up to a year from the usual sports such as soccer or handball in order to avoid a new injury.
