An MCL injury occurs when a force strikes the outside of the knee. The MCL tries to resist the force, causing stretching and tearing of the muscle fibres. So, what are the typical signs of a medial collateral ligament injury, and how do we treat it?
What is the medial collateral ligament?
The MCL, also known as the medial collateral ligament, is one of four stabilising ligaments of the knee. A ligament is made of rigid fibrous material and resists movement. The MCL starts at the end of the femur (thigh) and ends at the top of the tibia (shin). Generally, the primary function of the MCL is to stop the knee from opening up. If the MCL is completely torn, the knee will have an additional degree of laxity.
A tear occurs at the top attachment to the femur most of the time. However, the tear sometimes occurs at the tibia’s bottom attachment. Overall, tears at the bottom attachment take longer to heal.
Diagnosis of MCL injury
Generally, a medial collateral ligament strain occurs as an isolated injury or combined with other injuries to the ligaments or cartilage of the knee. The damage occurs during sports caused by bending, turning, or twisting. In addition, a blow to the outside of the knee can stretch and tear the MCL.
Usually, symptoms of a medial collateral ligament injury include:
- pain on the inside of the knee
- localised swelling at the site of ligament tearing
- a feeling of instability or buckling
- restricted ability to bend or straighten the knee
Overall, injuries are graded based on the severity of symptoms and how loose the knee is during an examination. Generally, a grade 1 injury is where there is no laxity; a grade 2 injury is a partial tear with some laxity; a grade 3 injury is a complete tear with significant laxity.
In some cases, an MRI scan of the knee is needed to confirm the damage to the medial collateral ligament and rule out harm to other ligaments (like the ACL) or meniscus.
Medial collateral ligament injury vs. meniscal injury: how can you tell?
Generally, an MCL injury occurs at the top attachment to the femur. So, pain and swelling are above the joint line. On the other hand, a medial meniscal tear causes pain in the medial joint line below the top attachment of the MCL. Also, a meniscal tear can cause general knee swelling, giving way or locking. Therefore, differentiating between the two problems requires a careful examination by a specialised doctor.
ACL vs. MCL injury
Generally, ACL injury is more traumatic and causes worse pain than MCL injury. Often, people hear a pop or feel a tear during an ACL injury. In addition, there is significant generalised swelling through the entire knee. Examination of the knee demonstrates laxity with ACL testing.
Treatment of MCL injury
Overall, treatment depends on the grade and severity of the injury.
Initially, we start with simple treatments such as regular ice, ibuprofen tablets, and a compression sleeve. Next, bracing is used in grades 2 and 3. Finally, we use a hinged knee or limited motion brace in higher-grade injuries. These braces protect the knee from side-to-side movement. In some cases, we restrict the direction of the knee from 20 to 100 degrees to allow the ligament to heal. Typically, we use braces for 4-8 weeks until stability and strength return.
Then, we move on to mobility exercises to regain the movement.
MCL injury exercises
Finally, rehab focuses on strength and balance before returning to sport. Compound exercises such as weighted squats, lunges, deadlifts, incline leg press, and calf raises regain knee strength. In the latter stages, we add more demanding tasks in a progressive way, such as jogging, running, sprints, and side-to-side movements. In this way, your chances of reinjury are reduced.
Frequently asked questions about MCL injury.
MCL injection: Is it helpful?
We rarely use ultrasound-guided injections to aid the healing of MCL strains. However, some doctors use PRP or dextrose to assist in healing. Overall, no evidence exists that an MCL injection will improve or accelerate recovery.
Pellegrini-Stieda or MCL calcification: what is it?
Pellegrini-Stieda syndrome is used to describe medial collateral ligament calcification during healing progress. Sometimes, calcium deposits form within the MCL at its top attachment. X-ray or ultrasound can detect calcium deposits. People often describe gradual worsening of stiffness and pain during the recovery process.
Generally, treatment consists of ibuprofen tablets and physiotherapy. In addition, we use an ultrasound-guided cortisone injection to break up the calcium in some cases.
Is surgery an option in MCL injury?
Generally no. But the surgeon might also repair the MCL in grade 3 injuries involving other ligaments (such as ACL).
How long does an MCL injury take to heal?
Generally, the time to return to sport depends on the grade of injury. Overall, grade 1 takes 2-3 weeks, grade 2 takes 6-8 weeks, and grade 3 takes up to 12 weeks. However, depending on other injuries or the type of sport, you may be a little more or less than these suggested timelines. For example, football players often take longer as side-to-side movements and kicking put pressure on the MCL.
Also, an injury to the lower part of the ligament toward the attachment to the shin (tibia) often takes twice as long as the more common injury closer to the thigh bone.
What about an LCL injury? Do we treat LCL injury the same?
Generally, an LCL injury occurs when the knee bends outwards excessively from trauma or a fall. Like MCL, an LCL injury can be graded depending on severity.
While there are similarities to MCL rehab, LCL injuries have a few differences. Firstly, bracing needs to be a bit different. Secondly, a grade 3 tear usually needs surgical repair or reconstruction. Finally, LCL injuries are more likely to be associated with other ligament or cartilage injuries.
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