Medial Collateral Ligament Injury

Medial Collateral Ligament Injury

What is it?

The medial collateral ligament (MCL) is one of the four important ligaments that stabilize the knee joint. The MCL is a long, flat band attached to the top inside of the tibia (shin bone) and to the bottom inside of the femur (thigh bone). Ligaments are made of inelastic tough fibrous material that serve to control and limit movement of a joint. The MCL is the primary restraint to inward motion of the tibia on the femur. In addition the MCL controls knee extension (straight knee), outward rotation of the tibia bone on the femur bone and helps to prevent forward movement of the tibia on the femur.

How it Happens?

MCL injuries happen in various conditions. Most common MCL injuries occur during contact sporting activities such as hockey, football or soccer and sports that place strain on the inside of the knee joint such as downhill skiing. Other mechanisms that can cause an MCL tear include severe trauma such as in a motor vehicle accident and work injuries in which the shin bone rotates outward and the thigh bone is pushed inward while the shin bone is fixed on the ground (valgus stress on the knee joint).

Symptoms

The following symptoms are common findings after an MCL injury:

Sudden onset of pain, along with a feeling of the joint ‘giving out’ or buckling and tenderness at the site of the tear around the inside of the knee joint.
An MCL tear may present with swelling of the joint.
Pain is often continuous, deep and fairly localized. It increases with any movement that stresses the ligament.
Patient may hobble when walking and keep the knee slightly bent

Testing

MRI is used to view tears of the MCL. X-ray does not show ligament structures.

Causes

The MCL is most commonly injured during sporting activities when a person suddenly pivots causing excessive rotational forces on the ligament. Other mechanisms that can cause an ACL tear include forcing the knee into hypertension or a blow on the outside of the knee forcing the femur inward while the tibia is bent outwardly to the side. One of the most common mechanisms occurs when a football player is tackled from the side with the foot planted and the knee slightly bent as the player tries to “cut away.” In this case, not only does the ACL tear but also the medial meniscus and the medial collateral ligament (MCL) resulting an the injury commonly known as the “terrible triad.”

What Should You Do?

Following an MCL injury the primary goal is to reduce the swelling and inflammation and provide relief for the pain. This is done by placing an ice pack on the knee for 10 minutes at a time, several times a day. The knee should be moved only within the within the pain free range to allow the healing process to proceed without further damaging the MCL. Twisting and full bending of the knee should be avoided.

Will Physiotherapy Help Me?

It is very rare that MCL injuries require surgical intervention.

Physiotherapy can offer helpful ways to enhance the healing process of the MCL. Initially the physiotherapist will place an emphasis on the control of swelling, inflammation and pain. As the healing process progresses the physiotherapist will concentrate on the flexibility and strength of the joint.

The physiotherapist will offer appropriate exercise sequences to enhance the strength around the knee, and to prevent future injuries to the knee.

Bracing may also be required if the stability of the ligament is insufficient.

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