MCL Injuries

The medial collateral
ligament (MCL) of the knee is a thick ligament found along the inside of the
knee. Connecting the femur and the tibia this ligament stabilizes and limits
the sideways motion, or “opening” the inside, of the knee joint.  The MCL is one of the most common knee
injuries in competitive and recreational sports and can occur from impact in
contact sports or from non-contact circumstances. MCL injuries can occur alone
or in combination with injury to other ligaments of the knee.

Mechanism of Injury:

• Any Valgus stress to
  the knee (Force applied to the outside of the knee, or combination of outside
  force and outside rotation force to the knee, or falling to the side with the
  foot firmly fixed)
• The knee is usually
  partially flexed

 

Signs and Symptoms: 

• Feel a “pop” in the
  knee (could be torn ligament)
• Feel the knee shift (could
  be significant torn ligament)

 

There are 3 degrees of sprains to the MCL:

 

1^st Degree: few ligament fibers are injured

• Local tenderness and
  pain to the medial aspect of the knee
• None or minimal
  swelling
• Negative joint laxity
  to valgus stress test at 30 degree knee flexion but pain is apparent

2^nd Degree: damage to ligament fibers but ligament is
not completely torn

• Local tenderness and
  pain to the medial aspect of the knee
• Some swelling
• Positive joint laxity
  to valgus stress test at 30 degree knee flexion but there is still a visible
  end point to lateral joint movement indicating the ligament is still attached
• Knee is stable when
  fully extended

3^rd Degree: full tear to the ligament

• Local tenderness to
  the medial aspect of the knee
• Knee is unstable and
  will “open” medially when valgus stress test at 30 degrees is applied with no
  distinct end point
• Knee has difficulty
  going into full extension
• The lateral meniscus
  may also be injured along with the anterior cruciate ligament (ACL)
• Swelling will occur

 

On-Site Management:

P.R.I.C.E. 

PROTECT the area from further injury by avoiding exercises that
produce pain. A neoprene sleeve, brace or taping technique can be used to
support the MCL and weight bearing should be avoided.

REST: cutting back on the amount of training can be difficult,
but key to recovery. Gradually return to any running or agility exercises with
guidance from a therapist.

Place ICE on the inside of your knee for 10-20 minutes every 1.5
to 2 hours for the first 2 to 3 days or until the pain goes away.

COMPRESS the area by using a knee wrap with a compression
bandage. This helps decrease swelling and bleeding. A hinged knee brace can
allow the patient joint support and compression during the initial
rehabilitation period which is usually 4-6 weeks in duration.  The level of bracing needed should be
recommended by the therapist as knee braces available range in levels of
support.

ELEVATION is important to encourage blood flow to the heart for
healing.

 

Medical Referral and Rehabilitation: 

When any degree MCL sprain it is important that the athlete
seeks medical attention. A doctor may prescribe anti-inflammatory medication to
help with pain and swelling. The athlete should be a certified therapist who
can provide rehabilitation treatment and monitor the athlete’s return to play.

 

Most treatment and rehabilitation plans include:

• Increasing flexibility
  in both flexion and extension
• Cryotherapy and
  electrotherapy to promote healing
• Manual therapy to
  assist in healing and range of motion
• Gait re-education and
  patient education
• Monitored exercises to
  gain strength, proprioception through neuromuscular retraining, sport specific
  movements and flexibility
• A knee brace to
  control your joint movement.

• Strengthening the quadriceps,
  hamstrings, VMO, calf, abductors and adductors are all important to strengthen
  as they aid in the ligaments abilities to stabilize the knee joint
• Walking will progress to
  jogging, biking or swimming before progressing to agility movements and
  sport specific movements such as cutting, hoping and changing direction

 

Specific
protocol including rehabilitation treatment techniques and timelines will alter
depending on the degree of injury.  
Crutches and/or a brace may be recommended initially post-injury but as rehabilitation
progresses they will no longer be needed.

 

Prevention: 

Although MCL strains
through a severe force to the later aspect of the knee may be inevitable there
are precautions athletes can take to avoid sustaining an MCL injury.

• Balancing Exercises.
  Your workout routine should include any activity that challenges your ability
  to balance and keep your balance this initiates the proprioceptive mechanisms
  surrounding the knee to activate muscles involved in stabilizing the knee to
  control joint movement and avoid injury
•  Stretch and
  Strengthen. To prevent a MCL injury, it is important that your muscles around
  the knee are well conditioned for your sport. This includes working on the
  strength and flexibility of all your muscles that make up your leg.
• Footwear. A good pair
  of training and competition shoes will help to keep your knees stable. They
  also provide the necessary cushioning and support that your knees and lower leg
  needs during running.
• Strapping. For an
  added level of support and stability strapping and taping can help weak and
  injured knees feel more stable.  These
  support mechanisms should not be solely relied on.
• Technique.  Ensuring that proper biomechanical techniques
  both in running and sport specific movements are taught and followed can help
  to prevent MCL injury

 

 

Contributions by Nicole Cook

 

Brukner, P.
and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical
Sports Medicine. 4th ed. North Ryde: McGraw-Hill.

 

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