From runners to splints

Knee injuries are quite common when playing football or during skiing. But another danger lurks in winter: sledding.

“It happened so quickly that there was no time to think.” When Olivia Walliser talks about her sledding accident in Switzerland, you can still notice her surprise about how quickly a seemingly harmless winter activity can turn into a painful reality. “We were going too fast, we came off the track, and we crashed. I fell on my right side. I immediately felt a stabbing pain in my knee.” This meant a sudden end to ride on the runners. The student realized straight away that she had suffered more than just bruises. After receiving first aid on site, she contacted orthopedist Dr. med. Anton Sebesta, founder of Basel Sports Clinic at Hirslanden Hospital Birshof in Münchenstein, without delay. 

MCL injuries in the knee – three grades of severity

“The patient suffered an isolated partial rupture of the medial collateral ligament in the right knee, a grade-2 injury,” explains Dr. Sebesta. “The likely cause was a valgus trauma she sustained when by falling from her sled.” Medial collateral ligament injuries of the knee can be divided into three grades of severity¹. Grade I is overstretching of the MCL. The patient feels pain during the valgus stress test, but the knee remains stable. Stage II means a partial rupture of the MCL, which was the case with Olivia Walliser. During the test, knee gapping of three to four millimeters can be observed at 30 degrees of flexion, but the knee remains stable during extension. Grade III means a complete rupture of the MCL has occurred. There is knee gapping and instability during the valgus stress test, both when bent to 30 degrees and during extension,” the orthopedist explains. 

A non-surgical approach is needed

“One in three of all sports injuries involve the knee,” Dr. Sebesta reports. Affected structures usually include the menisci as well as the cruciate and collateral ligaments. An injury to the medial collateral ligament is one of the most common ligament injuries of the knee². It is caused by valgus trauma, often associated with a rotational movement in the joint. Treatment of the medial collateral ligament depends on the severity of the injury and the patient’s activity level. Grade-I or II injuries are usually treated conservatively. Grad III can be treated surgically or non-surgically, depending on how active the patient is. During the conservative approach, it is essential to prevent inward movements of the knee, i.e. valgus movements, that most likely caused Olivia Walliser’s injury. This movement limitation can be achieved with supports and braces that feature guiding splints on the sides. “This type of orthopedic aid plays a crucial role in the treatment of isolated medial collateral ligament lesions,” Dr. Sebesta explains: “They have to provide relief to the medial collateral ligament, meaning they must prevent movements to the sides, while allowing flexion and extension of the knee joint.” 

GenuTrain S for mild to moderate instability 

In Olivia Walliser’s case, the sports orthopedist chose conservative treatment using Bauerfeind’s GenuTrain S active support. Thanks to its hinged side bars, this support guides the knee in its correct axis. Its elastic Train knit exerts an intermittent compression massage during movement to promote recovery. This activates the joint-stabilizing leg muscles. The patient had to wear the support for six weeks. During this time, she had regular physiotherapy. In addition to coordination exercises, the goal was to restore the range of motion of the joint with regard to the extension deficit associated with medial ligament injuries. During the training sessions, Olivia Walliser wore the GenuTrain S on her knee. 

“With the Bauerfeind support, I felt confident and safe. I had the feeling that my knee could heal.” 

Olivia Walliser 

A curious experience at the end

“I got on well with the support,” says Olivia Walliser, describing everyday activities with the GenuTrain S. “Since it’s quite thin, it fits under loose-fit pants. I only took it off to have a shower. I had no problems putting it on or taking it off. The support provided total stabilization. Initially, the physician at the ski resort gave me a different support that did not feature stabilizing splints. I was barely able to walk with it. But with the Bauerfeind support, I felt confident and safe. I had the feeling that my knee could heal.” She had a curious experience at the end: “During the final exercises, the right knee, which was injured, was actually more stable than the left knee,” she says and laughs. The 23-year-old now feels confident. “I’m not worried about subjecting my knee to strain. Only very rarely do I have even a small sensation of pain. But that doesn’t restrict me at all. I even went surfing in the summer.” This is no coincidence for Dr. Sebesta: “A support has to be sturdy and – hugely important – comfortable and suitable for everyday use. If this is the case, patients will wear it and it can be effective. It was a very successful treatment with the GenuTrain S. The patient can return to her sporting activities, just like I wish for all my patients.”

1 Hughston et al. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. In: The Journal of bone and joint surgery. American volume.
   Band 58, Nummer 2, 1976, p. 159–72.
2 Heitmann, M., Preiss, A., Giannakos, A. et al. Akute mediale Seitenbandverletzung am Kniegelenk. Unfallchirurg 116, 497–503 (2013). https://doi.org/10.1007/s00113-013-2371-8

Images: Bauerfeind/Remo Neuhaus