Musculoskeletal Disorders: Knee

Introduction

Using the functional framework presented in Appendix A, the law enforcement officer (LEO) with adequate active range of motion (ROM) of the knee, no knee instability, and adequate quadriceps strength who can perform training activities with minimal discomfort, should be cleared for unrestricted duty.

Anterior Cruciate Ligament (ACL) Injuries
ACL Injuries NOT Requiring Repair
LEOs with ACL injuries that have been evaluated and determined to not require surgical repair can typically be ready to return to unrestricted duty after 8 to 12 weeks. They can return to unrestricted duty once they have successfully completed physical training (see Proposed Assessment for Medical Clearance for any Knee Disorder in Appendix A).

ACL Injuries Requiring Repair
LEOs with surgical repair of an isolated anterior cruciate ligament injury can typically be ready to return to unrestricted duty after 6 to 8 months. They can return to unrestricted duty once they have successfully completed physical training (see Proposed Assessment for Medical Clearance for any Knee Disorder in Appendix A). ACL injuries with concomitant injuries – i.e., meniscus, medial collateral ligament (MCL) – with or without surgical repair may require a longer rehabilitation course.

LEOs without surgical reconstruction of the ACL where surgery was recommended may require restrictions and should be evaluated with job simulation tasks (see Proposed Assessment for Medical Clearance for any Knee Disorder in Appendix A).

Collateral Ligament/Posterior Cruciate Injuries
Collateral Ligament/Posterior Cruciate Injuries NOT Requiring Repair
LEOs with collateral ligament injuries that have been evaluated and determined to not require surgical repair may be ready to return to unrestricted duty as soon as 2 weeks for Grade 1 injuries. They can return to unrestricted duty once they have successfully completed physical training (see Proposed Assessment for Medical Clearance for any Knee Disorder in Appendix A).

Collateral Ligament/Posterior Cruciate Injuries Requiring Repair
LEOs with surgical repair of an isolated collateral ligament injury can typically be ready to return to unrestricted duty after 3 to 4 months. They can return to unrestricted duty once they have successfully completed physical training (see Proposed Assessment for Medical Clearance for any Knee Disorder in Appendix A).

Meniscus Conditions
LEOs with isolated meniscal injuries (see Appendix A) can typically be ready to return to unrestricted duty 5 to 6 months post-surgery meniscal injuries with concomitant injuries – i.e., ACL, MCL – with or without surgical repair may require a longer rehabilitation course. LEOs can return to unrestricted duty once they have successfully completed physical training – to include defensive tactics, running and jumping (see Appendix A).

LEOs without surgical reconstruction of a meniscus injury with objective signs of laxity that affects function or subjective instability are likely to require restrictions.

Meniscal tears without objective signs that affects function of laxity or subjective instability (see Appendix A) may or may not benefit from surgical repair, particularly in the setting of mild to moderate osteoarthritis. In either case, the LEO who has successfully completed physical training (Appendix A) should be able to perform the essential LEO job functions.

Femoro-Tibial Articular Cartilage Conditions
These conditions (knee osteoarthritis) should be evaluated according to the guidance provided in Appendix A.

Patellofemoral Joint Conditions
These conditions (e.g., bursitis) should be evaluated according to the guidance provided in Appendix A.

Knee Arthroplasty (see also Appendix B)

Unicompartmental
The Task Group’s consensus opinion is that a well-motivated LEO with a primary unicompartmental arthroplasty and uneventful post-operative recovery, normal quadriceps strength, and adequate range of motion, AND no evidence of an underlying systematic process that would otherwise restrict her/his ability to perform essential job functions is likely to be cleared for unrestricted duty.

Unilateral
The LEO Task Group’s consensus opinion is that a well-motivated LEO with a primary unilateral total knee replacement (TKA) with an uneventful post-operative recovery, normal quadriceps strength, and adequate range of motion, AND with no evidence of an underlying systematic process that would otherwise restrict her/his ability to perform essential job functions is likely to be cleared for unrestricted duty. Return to low-impact physical training is anticipated after 3 months. Return to unrestricted duty could be considered after successful completion of physical training (see Appendix A).

Bilateral
The LEO Task Group’s consensus is that LEOs with bilateral TKA are likely to need restrictions.