Medial Collateral Ligament Injury
The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).
The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents “opening-up” of the knee.
Cause
Because the MCL resists widening of the inside of the knee joint, the MCL is usually injured when the outside of the knee joint is struck.
This action causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury.
This is the injury seen by the action of “clipping” in a football game.
An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee.
Other ligaments, most commonly the ACL, or the meniscus (cartilage), may be torn along with a MCL injury.
Symptoms
Symptoms of a MCL injury tend to correlate with the extent of the injury. MCL injuries are graded on a scale of I to III.
Grade I MCL Tear
This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 2-4 weeks of play.
Grade II MCL Tear
Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 4-6 weeks of rest is necessary.
Grade III MCL Tear
A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
Diagnosis
Physical Examination & Patient History
During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy. Most injuries can be diagnosed with a thorough physical examination.
Imaging Tests
Imaging Tests Other tests which may help your doctor confirm your diagnosis include:
X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.
Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.
Treatment Options
Non-Surgical
Treatment of a MCL injury rarely requires surgical intervention. Almost always, some simple treatment steps, along with rehabilitation, will allow patients to resume their previous level of activity. The time before an athlete is able to return to their sport corresponds to the grade of the injury.
Grade I MCL Tears
Grade I tears of the MCL usually resolve within a few weeks. Treatment consists of:
- Resting from activity
- Icing the Injury
- Anti-inflammatory medications
Most patients with a grade I MCL tear will be able to return to sports within one to two weeks following their injury.
Grade II MCL Tears
When a grade II MCL tear occurs, use of a hinged knee brace is common in early in early treatment. Athletes with a grade II injury can return to activity once they are not having pain over the MCL. Patients with a grade II injury often return to sports within three to four weeks after their injury.
Grade III MCL Tears
When a grade III tear occurs, patients usually wear a knee immobilizer and protect weight bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.
Once the patient can flex the knee at least to 100 degrees, they may begin riding a stationary bicycle. The crutches can be discontinued once the patient is able to walk without limping. Jogging can begin once the patient has regained 60% of their quadricep strength (compared to the opposite side), and agility drills can begin once they have regained 80% of their strength. Complete rehab from a grade III MCL tear can take three to four months.
Conservative Treatment Options
Treatment Highlights
