Medial Collateral Ligament (MCL) Tears
The Medial Collateral Ligament (MCL) is a key knee stabilizer. It is located on the inner side of the knee and runs from the femur (thighbone) to the tibia (shinbone). It helps to prevent the knee from buckling inwards.
Knee ligament injuries account for about 40% of all injuries, and injuries to the medial collateral ligament are the most common. A tear of the medical collateral ligament is the single most common traumatic knee injury in contact sports such as football, ice hockey, wrestling, and judo.
Injuries can be an isolated tear but more commonly occur in conjunction with other injuries to the knee. For example, the “unhappy triad” is concomitant injuries to the Medial Collateral Ligament, Anterior Cruciate Ligament and medial meniscus.
An MCL tear is a common sports injury especially in skiing. 60% of skiing knee injuries involve the medial collateral ligament. It is caused by an abrupt turning, cutting or twisting, or from a direct blow to the outside of the knee.
- Grade I is a mild injury that involves some stretching and tearing of the ligament fibers, but the ligament is still intact and functional.
- Grade II is a moderate injury where the ligament is partially torn but is not completely disrupted. This grade often involves more significant pain, swelling, and tenderness on the inside of the knee.
- Grade III is a severe injury where the ligament is completely torn or ruptured. This grade often involves significant pain, swelling, and instability of the knee joint.
- Pain and tenderness along the inner part of the knee
- Swelling and bruising in the knee area
- Feeling of instability in the knee; it may feel like the knee will give way under stress
- Difficulty bending or straightening the knee
- Difficulty walking
- Hearing or feeling a pop at the time of injury
Dr. Masi will review your medical history and the history of your injury, and perform a physical examination checking for tenderness, swelling and stiffness. He will move your knee to test the integrity of the MCL. He will also test other knee ligaments to determine if the injury is more than only a tear of the MCL.
Dr. Masi will order X-rays to rule out a bone fracture, and an MRI because it is the most accurate imaging study to evaluate ligament injuries, including MCL tears. Ultrasound evaluation may be faster.
In most cases treatment is conservative nonsurgical for isolated Grade I and II medial collateral ligament injuries, and sometimes for Grade III injuries. This is because the medial collateral ligament has a good blood supply. Conservative treatment for Grade I and II injuries has been shown to be effective in 98% of athletes.
- I.C.E. protocol (Rest, Ice, Compression, and Elevation)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation
- Use of a knee brace to provide stability during healing
- Physical therapy exercises to restore strength and range of motion
- Injection therapy with Platelet rich plasma and/or Cortisone
Surgical Treatment: Surgical intervention for isolated medial collateral ligament tears is generally reserved for complete Grade III tears that do not respond to non-surgical treatment or when the medial collateral ligament tear is associated with other ligament injuries in the knee. Surgery involves repairing or reconstructing the torn medial collateral ligament.
Acute tears may be repaired, but chronic tears may require reconstruction using an allograft or autograft.
Regardless of whether treatment is surgical or non-surgical, rehabilitation plays a crucial role in the recovery from an MCL tear. Physical therapy exercises that focus on restoring strength, stability, and range of motion to the knee are central to the rehabilitation process.
The recovery time for an MCL tear varies depending on the grade of the tear and the treatment approach. People with Grade I tears can expect to recover with conservative treatment in 10 to 14 days. For Grade II tears, recovery time varies from a few weeks to a few months. For Grade III tears, especially if surgery is required, the recovery time may be longer.