Amongst all knee injuries, medial collateral ligament (MCL) injuries are most prominent amongst high school and collegiate athletes, and professional American football players. Isolated MCL injuries typically occur with a valgus force (force coming from outside of knee going inward) while the knee is in flexion and may occur in either a non-contact or contact setting. If you believe you may have a MCL injury, you may require reconstructive surgery to regain functioning of the ligament prior to returning to physical and/or daily activities. Although, there are non-surgical treatments available that may help alleviate pain.
The role of the MCL is to be a prime stabilizer in the medial aspect of the knee. In addition to this, the MCL provides support against valgus forces (forces coming from outside of knee), anterior translational forces, and rotational forces.
When the MCL is injured, orthopaedic surgeons will classify the injury and grade it depending on the severity. Although a thorough physical examination many times provide adequate information to determine the severity of the MCL injury, additional imaging such as X-Ray or MRI may be required to more confidently illustrate degree of the injury.
If you have a MCL injury, you may experience one or several of the following symptoms:
- Pain (may range from mild to severe)
- Swelling or effusion of the knee joint
- Stiffness of the knee
- Tenderness along inside of the knee joint
- Instability (a feeling that the injured knee may give away; knee locks or “catches”)
Determination of treatment is extremely dependent on the severity of the MCL injury. Although many grade I and grade II MCL injuries can be treated conservatively with early rehabilitation, strength training, and range of motion exercises, in severe cases MCL injuries treated non-operatively may lead to instability and/or arthritis.
MCL injuries can often times be managed non-surgically via adequate bracing, rest, and physical therapy in order to return the patient to pre-injury performance. This is many times seen with grade I and grade II MCL injuries, but, it is possible for an isolated, grade III MCL injury to be treated non-surgically. Although, it should be noted that when non-surgical treatments fail, the patient may be at risk for instability of the knee, weakness of the knee, and/or osteoarthritis.
Depending on factors such as time since injury, knee alignment, presence of an avulsion (MCL tears off at bone), and presence of concomitant injuries, surgical treatment may be advised. This is typically seen in patients with acute injuries, the addition of severe malalignment of the knee, MCL entrapment via surrounding structures, or an avulsion. Depending on the current status of the injury, different surgical options will be considered in order to restore the MCL to its pre-injury condition, such as repair, reconstruction with a semiteninosus graft, or a combination of the two.
In any case of treatment, rehabilitation and physical therapy play a critical role in helping you return to your daily activities. Physical therapy programs help restore knee strength and motion. In the case of MCL reconstruction, physical therapy focuses on returning movement to the surrounding muscles and knee, which is followed by a strengthening treatment to maintain and protect the new ligament. Finally, in the last step of rehabilitation the methods are customized for a safe return to the athlete’s sport.