The medial collateral ligament (MCL) is a broad, thick band found on the inside area of the knee. It runs from the upper/inside surface of the shin bone (tibia) to the bottom/inside surface of the thigh bone (femur). This ligament stabilizes the joint on the inside of the knee. The MCL is one of the most common knee injuries in competitive and recreational soccer. It can occur by itself or in combination with other ligaments.

Mechanism of Injury

• Outside stress to the knee (i.e. when your soccer player's foot is caught while preparing to kick the soccer ball with the side of the foot).

• Combined outside force and outside rotation force to the knee (i.e. when your player's cleat is stuck while attempting to cut away from that side).

• Direct blow to the outside part of the knee (i.e. from a side tackle).

• Non-contact through fall to the side with the foot firmly fixed.

There are 3 degrees of sprains to the MCL:

• With a first degree sprain only a few ligament fibers are injured.

• A second degree sprain includes more damage to the ligament fibers but the ligament is not completely torn.

• Third degree MCL sprain causes you a lot of pain because there is a complete rupture of the ligament. This massive amount of damage causes other structures (meniscus and ACL) to be affected.

Signs and Symptoms

• Did your athlete feel a “pop”? (could be torn ligament)

• Did his knee shift? (could be significant torn ligament)

• Was he able to continue playing soccer? (often with grade 2 or 3 cannot)

• Was there swelling 1-2 hours after his injury?

o       Significant swelling following isolated grade 1 or 2 sprain is rare.

o       If ACL also injured significant swelling is common.

• Positive stress test for inside ligament of his knee.

• What is the range of motion of his knee joint? (can be increased from loose ligament or decreased from significant swelling)

·         Tender to the touch over MCL.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury by avoiding soccer exercises that produce pain. A neoprene sleeve, brace or taping technique can be used to support the MCL. REST: cutting back on the amount of soccer training can be difficult, but key to recovery. Gradually return to any running or agility soccer exercises. Place ICE on the inside of your soccer player's 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. ELEVATION is important to encourage blood flow to the heart for healing.

Medical Referral. When there is a severe 2^nd or 3^rd degree MCL sprain it is important that you and your player seek medical attention. A doctor may prescribe anti-inflammatory medication to help with pain and swelling. Your athlete should see a therapist for proper evaluation of soccer running/agility biomechanics and footwear. The therapist can also direct the athlete to proper treatment and strengthening activities for return to soccer play.

Rehabilitation. Your soccer player should find a therapist to assist with evaluation. A MCL/soccer specific rehabilitation plan is needed if she has a MCL injury.

Most rehabilitation plans include:

• Passive range of motion exercises to increase her flexibility.
• A knee brace to control her joint movement.
• Exercises to strengthen her quadriceps muscles in the front of her thigh. She will need muscle strength to provide support and stability of her knee joint when weight is put on it.
• Some exercises can be started on a high seat exercise bicycle and progress to more difficult exercises for the quadriceps.

Crutches and/or a brace can be used but as she progress and her knee functions more towards normal they will no longer be needed. 

Return to Activity. This is a gradual process and may take some time. In general, the longer your athlete has symptoms before he starts treatment, the longer it will take to rehabilitate. The following is a list of guidelines to follow when returning to soccer activity.

• Work towards full range of motion in the affected knee compared to the unaffected one.
• Work towards full strength of the affected knee compared to the unaffected one.
• Work towards jogging straight ahead without pain or limping.

For competitive soccer player's, her therapist may include the following performed on the soccer field:

• Your player can sprint straight ahead without pain or limping.
• She can do 45-degree cuts, first at half-speed, then at full-speed. You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.  
• She can do 90-degree cuts, first at half-speed, then at full-speed.
• She can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
• She can jump on both legs without pain and you can jump on the affected leg without pain. (Pierre Rouzier, M.D).

Prevention. To prevent a MCL sprain from becoming chronic your athlete should use proper techniques when playing doing any soccer activities. Many cases are not preventable but considering the following can support the ligament during activity.

Balancing Exercises. His workout routine should include any activity that challenges his ability to balance and keep his balance.

Stretch and Strengthen. To prevent a MCL injury, it is important that his muscles around the knee are well conditioned for his sport. This includes working on the strength and flexibility of all his muscles that make up his leg.

Footwear. A good pair of training and competition turf shoes or soccer cleats will help to keep his knees stable. They also provide the necessary cushioning and support that his 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.

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