MCL INJURY

MEDIAL COLLATERAL LIGAMENT

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 medial collateral ligament 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.

HOW MEDIAL COLLATERAL LIGAMENT INJURED?

Because the medial collateral ligament 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 medial collateral ligament 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 medial collateral ligament may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the anterior cruciate ligament (ACL), or the meniscus (cartilage), may be torn along with a medial collateral ligament injury.

SYMPTOMS OF A MEDIAL COLLATERAL LIGAMENT INJURY

v The most common symptom following a medial collateral ligament injury is pain directly over the ligament.

v Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury.

v In more severe injuries, patients may complain that the knee is unstable, or feel as though their knee may 'give out' or buckle.

v Symptoms of a medial collateral ligament 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 1-2 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 3-4 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.

TREATMENT

PHYSICAL THERAPY

The type of physical therapy (PT) treatment indicated for a medial collateral ligament (MCL) injury depends on the severity of the injury.

Recommendations for treatment of MCL Injury include the following:

• Grade I - Compression, elevation, and cryotherapy are recommended. Short-term use of crutches may be indicated, with weight-bearing–as–tolerated (WBAT) ambulation. Early ambulation is recommended.

• Grade II - A short-hinged brace that blocks 20º of terminal extension but allows full flexion should be used. The patient may ambulate, WBAT. Closed-chain exercises allow for strengthening of knee musculature without putting stress on the ligaments.

• Grade III - The patient initially should be non–weight-bearing (NWB) on the affected lower extremity. A hinged braced should be used, with gradual progression to full weight-bearing (FWB) over 4 weeks. Grade III injuries may require 8-12 weeks to heal.

All MCL injuries should be treated with early range of motion (ROM) and strengthening of musculature that stabilizes the knee joint.

Conservative measures usually are adequate, but, if the patient fails to progress with treatment, a meniscal or cruciate ligament tear is suggested.

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 sprains 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 1-2 weeks following their injury.

GRADE II MCL TEARS

When a grade II MCL sprain occurs, use of a hinged knee brace is common 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 3-4 weeks after their injury.

GRADE III MCL TEARS

When a grade III injury 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 one the patient is able to walk without limping.

Jogging can begin once the patient has regained 60% of their quadriceps strength (compared to the opposite side), and agility drills can begin one they have regained 80% of their strength.

Complete rehab from a grade III MCL tear can take 3-4 months.