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MCL Injury

MCL Injury

The collateral ligaments are present to provide stability to the knee joint and consist of the Medial Collateral ligament, Lateral collateral ligament, and Anterior collateral ligament. The medial collateral ligament (MCL) is located on the inside of the knee, while the lateral collateral ligaments (LCL) are located on the outside of the knee. The MCL runs from the medial part of the femur to the medial tibia and is vulnerable to trauma caused by knee injuries. (1) (2) (3)

Common Causes of MCL Injury

MCL injury may be caused by abrupt changes in motions, which may result in twisting, turning, or cutting of the medial collateral ligaments. The collateral ligament injuries may also be caused by a direct blow to the knee, which results in extreme internal stresses. While these injuries may occur on their own, they are more commonly associated with injuries to the surrounding structures resulting in muscle sprains affecting the hamstrings or fractures of any part of the knee. It may also be associated with Medial collateral ligament tears, either complete or partial tears. The MCL sprains and tears are most often seen in individuals who are involved in contact sports which may lead to sports injury. (4) (5) (6)

Medial Collateral Ligament Injury Symptoms

Individuals with medial collateral ligament injury often complain of knee pain, which may be acute or chronic in nature. In the cases of acute pain, the individual usually gives a history of recent trauma, which is responsible for their injured knee. Many individuals also report swelling along with knee pain due to the inflammatory process taking place at the Medial collateral ligament. The meniscal tear, which may be complete tear or incomplete tear, may also be associated with a limited range of motion, a popping sound, or a sudden sharp pain on the inside of your knee. However, the pain caused by a meniscus tear may also radiate to the side of your knee. On pressing the affected knee, the individual may also complain of tenderness, which is one of the key diagnostic factors the healthcare physician may look for during physical examination.

The laxity in MCL may be classified into three grades which include:

·         Grade 1: Grade 1 is associated with no joint opening. However, the patient may experience pain along the medial collateral ligament.

·         Grade 2: Grade 2 is associated with a slight opening of the joint. However, it has a firm endpoint.

·         Grade 3: Grade 3 is associated with a major joint opening with no endpoint.

How is MCL Injury Diagnosed?

Whether it is a medial collateral ligament (MCL), Posterior cruciate ligament (PCL), or other types of knee ligament injuries, the health professional may start by conducting a detailed medical history and physical examination. The orthopedic experts may also be consulted, who may suggest further imaging tests. The common imaging tests performed for MCL injury include X-rays and Magnetic Resonance Imaging. While x-rays are more focused on the hard surfaces, the MRI scan allows a detailed examination of the soft tissues around the knee. (7) (8) (9)

Treatment Options For MCL Injury

The treatment recommended by healthcare providers specializing in orthopedics is usually conservative in nature. They may include NSAIDs like Ibuprofen, Physical therapy, elastic bandage, and knee brace. A trained physical therapist commonly recommends the knee brace to relieve the symptoms of swelling before the patient can begin their physical therapy targeting the thigh bone, shin bone, and surrounding musculature. While the recovery time may vary from individual to individual, however a lack of improvement from conservative therapy may require surgery. The orthopaedic surgeon may recommend an operative procedure for grade III injuries and associated ACL tears. (10) (11)

FAQs

How long does it take an MCL injury to heal?

The time it takes for an MCL injury or ACL injury to heal depends on the grade of injury and the health status of the affected individual. While the grade 1 or minor injuries may take from a few days to a week to fully heal, the grade 2 injuries may take from 2 weeks to a month.

Can you walk with an MCL injury?

An individual may be able to walk with MCL injury of minor grades; however, those with more severe injuries may not be able to move as effortlessly. This is because the injury to the MCL interferes with an individual’s knee stability, which may affect their gate. Moreover, as seen in grade 2 MCL tears, the pain associated with walking may also keep the individual from any physical activity until the area is healed.

How do you tell if MCL is torn or sprained?

In order to find the cause of MCL injury, the healthcare professional may first start by carrying out detailed medical history, followed by a physical exam. In order to find out if the individual has an MCL tear, they may be asked to bend their knee, after which the pressure is applied to it. This is done to analyze if the knee is loose, as seen in the MCL tear.

Which is worse, ACL or MCL tear?

While ACL and MCL tears are both a source of great discomfort for the majority of individuals, ACL tears are often reported to be more severe. This is because ACL tears are more difficult to treat due to their complex anatomy. This also makes them have a longer recovery time as compared to MCL tears.

Is walking good for torn ligaments?

Walking may be recommended after the pain and swelling associated with the torn ligament are adequately treated. However, the individual should try to keep their walks short and avoid overusing their knee joint during the healing period.

How do you sleep with a torn MCL?

While sleeping, the individual may find relief by keeping a pillow between the knee to support them. This may prove to be beneficial while the patient sleeps on their back. Individuals who sleep on their side may find relief by sleeping in a flexed position. They also avoid sleeping with their legs crossed and follow any other medical advice their orthopedic specialist recommends.

References:

1.       Desai, V. S., Wu, I. T., Camp, C. L., Levy, B. A., Stuart, M. J., & Krych, A. J. (2020). Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries. The journal of knee surgery, 33(8), 785–791. https://doi.org/10.1055/s-0039-1688689

2.       Loughran, G. J., Vulpis, C. T., Murphy, J. P., Weiner, D. A., Svoboda, S. J., Hinton, R. Y., & Milzman, D. P. (2019). Incidence of Knee Injuries on Artificial Turf Versus Natural Grass in National Collegiate Athletic Association American Football: 2004-2005 Through 2013-2014 Seasons. The American journal of sports medicine, 47(6), 1294–1301. https://doi.org/10.1177/0363546519833925

3.       Lundblad, M., Hägglund, M., Thomeé, C., Hamrin Senorski, E., Ekstrand, J., Karlsson, J., & Waldén, M. (2019). Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 27(11), 3692–3698. https://doi.org/10.1007/s00167-019-05491-6

4.       Elkin, J. L., Zamora, E., & Gallo, R. A. (2019). Combined Anterior Cruciate Ligament and Medial Collateral Ligament Knee Injuries: Anatomy, Diagnosis, Management Recommendations, and Return to Sport. Current reviews in musculoskeletal medicine, 12(2), 239–244. https://doi.org/10.1007/s12178-019-09549-3

5.       Jung, K. H., Youm, Y. S., Cho, S. D., Jin, W. Y., & Kwon, S. H. (2019). Iatrogenic Medial Collateral Ligament Injury by Valgus Stress During Arthroscopic Surgery of the Knee. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(5), 1520–1524. https://doi.org/10.1016/j.arthro.2018.11.054

6.       Westermann, R. W., Spindler, K. P., Huston, L. J., MOON Knee Group, & Wolf, B. R. (2019). Outcomes of Grade III Medial Collateral Ligament Injuries Treated Concurrently With Anterior Cruciate Ligament Reconstruction: A Multicenter Study. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 35(5), 1466–1472. https://doi.org/10.1016/j.arthro.2018.10.138

7.       Albtoush, O. M., Horger, M., Springer, F., & Fritz, J. (2019). Avulsion fracture of the medial collateral ligament association with Segond fracture. Clinical imaging, 53, 32–34. https://doi.org/10.1016/j.clinimag.2018.09.006

8.       DeFroda, S. F., Bokshan, S. L., Vutescu, E. S., Sullivan, K., & Owens, B. D. (2019). Accuracy of internet images of ligamentous knee injuries. The Physician and sportsmedicine, 47(1), 129–131. https://doi.org/10.1080/00913847.2018.1533393

9.       Encinas-Ullán, C. A., & Rodríguez-Merchán, E. C. (2018). Isolated medial collateral ligament tears: An update on management. EFORT open reviews, 3(7), 398–407. https://doi.org/10.1302/2058-5241.3.170035

10.   Goff, A. J., Page, W. S., & Clark, N. C. (2018). Reporting of acute programme variables and exercise descriptors in rehabilitation strength training for tibiofemoral joint soft tissue injury: A systematic review. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine, 34, 227–237. https://doi.org/10.1016/j.ptsp.2018.10.012

11.   Logan, C. A., Murphy, C. P., Sanchez, A., Dornan, G. J., Whalen, J. M., Price, M. D., Bradley, J. P., LaPrade, R. F., & Provencher, M. T. (2018). Medial Collateral Ligament Injuries Identified at the National Football League Scouting Combine: Assessment of Epidemiological Characteristics, Imaging Findings, and Initial Career Performance. Orthopaedic journal of sports medicine, 6(7), 2325967118787182. https://doi.org/10.1177/2325967118787182

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