Medial Collateral Ligament Injuries
Updated: May 23, 2019
A common injury to the knee is damage to the Medial Collateral Ligament (MCL). The MCL is one of the four major ligaments in the knee that provide resistance to excessive movement and when damaged it can either be sprained (partial tearing) or ruptured (complete tearing).
The knee is a synovial hinge joint and is made up by two bones called the femur and tibia. The knee joint moves in two directions flexion and extension (bending and straightening).
Stability to the knee is supplied, actively, via the quadriceps, hamstrings and calf muscles as well as passively by the cruciate ligaments (anterior and posterior), collateral ligaments (medial and lateral) and the meniscus.
The MCL is located on the inside of the knee and is made up of 2 bands of tough connective tissue which arises from the bottom of the femur and inserts onto the top of the tibia.
Its primary role is to provide resistance to any valgus forces of the knee, or inward motion of the knee. Similarly the LCL provides stability to the other side of the knee.
The most common causes of a MCL injury are:
1. A direct force is applied to the outside of your knee, forcing it inwards
2. A sharp change in direction
3. Landing from a jump incorrectly and allowing the knee to fall inwards
A tear or sprain of a ligament occurs when the fibres are overstretched beyond their movement capabilities. The severity of a ligament sprain is determined by the amount of stretching or tearing to the ligament and is graded as follows:
Grade 1: the ligament has been lightly overstretched with minimal tearing and minimal instability
Grade 2: the ligament has been partially torn with moderate to high pain and moderate instability
Grade 3: the ligament has been completely torn with moderate pain and high instability.
In grade 2 and 3 ligament tears there is a high possibility that other structures are damaged as well, given the amount of force and mechanism of injury. These structures can include the meniscus and the ACL.
Symptoms of a MCL tear include:
· Pain or tenderness on the inside of the knee over the MCL
· Swelling and or bruising
· Pain with terminal extension (straightening the knee)
· An audible popping noise at the time of the injury
· Feelings of instability or the joint giving way
All three grades of MCL injury respond very well to conservative management, and even complete tears tend to heal quite well without the need for surgery.
As mentioned earlier, the MCL is composed of two bands. At end range extension both of these bands are taut, whereas when we bend the knee these bands will loosen to a small degree. When the bands are both taut there is a constant stretch through the tissue which makes it more difficult for the ends of the ligament to approximate and heal.
As such, part of the management process, especially for GD 2 and GD 3 tears is to immobilise the knee in a hinged ‘range limiting’ brace. These braces are set, by your therapist, to allow only a certain range of movement. This prevents end range extension and protects the ligament as it heals. The time spent in the brace is usually between 4 and 8 weeks, with a progressive increase in the allowed range as healing takes place.
Once the brace is removed treatment includes restoring range of motion to the knee and any lingering pain management. Once full range has been restored and pain is under control a targeted strength program would commence to increase stability around the hip and knee to reduce risk of recurrence and further injury.
3 tips for minimising the risk of sustaining an MCL injury include:
1. Maintain good strength around the hip and knee
2. Wear supportive footwear, especially in sports. Poor footwear and foot posture can increase the amount of valgus at the knee, predisposing you to an MCL injury.
3. Avoid pivoting on a fixed foot where possible.
So that’s a brief overview of how MCL injuries occur, If you have questions or comments feel free to e-mail us at firstname.lastname@example.org and we will be happy to answer them for you or call us on (08) 9486 8653 and our therapists will be happy to talk with you.