Ligaments are tough bands of tissue that connect bone to bone and hold the knee in the proper position to bear weight and function properly. The medial collateral ligament (MCL) is one of the four major knee ligaments. The medial collateral ligament is a major stabilizer of the knee joint located on the inner side of the knee and controls side to side knee motions and restrains abnormal knee movements. It is the most common ligament injured in the knee, particularly in athletes, and has been reported to be torn in 40% of all knee injuries; and 7.9% of all athletic knee injuries.
A medial collateral ligament tear can happen when you make a sudden change in direction while playing sports, or while running or walking. It can also occur when you are hit hard on the outside of knee or when the knee is violently twisted. MCL injuries are common in football when the player is hit on the outside of the knee, from twisting and turning during skiing, or from a sharp turn while the foot is planted.
- pain on the inner side of the knee
- a popping sound at the time of the injury
- pain when trying to bend or straighten the knee
- Swelling and bruising which spreads to the rest of the knee several days after the injury
- Difficulty with weight bearing including any activity that requires bending the knee including walking, squatting
- A sense of instability or knee buckling
Dr. Patel will review your medical history including how you injured your knee and your symptoms. He will conduct a thorough physical exam testing knee laxity and range of motion, and at the same time will perform specific tests to identify damage to other knee ligaments. He will order x-rays to view the bones, and an MRI to view the soft tissues. He will grade the injury and recommend the treatment.
- Grade 1: A mild ligament strain with small tears but no instability
- Grade 2: Partial tear with looseness, pain, tenderness and swelling on the inner side of the knee
- Grade 3: Complete tear is usually associated with other related injuries
MCL injuries can be successfully treated conservatively. Return to play is high. However, professional athletes may prefer surgical repair to prevent the risk of future injuries.
Grade 1 injuries can be managed without a brace but with crutches to prevent weight bearing and restrict side to side motion. In addition, nonsurgical management will include rest, icing, compression, physical therapy, and anti-inflammatory medications for pain. Grades 2 and 3 will require a hinged brace for at least 4-6 weeks to stabilize the knee because instability can lead to added knee damage and degenerative knee osteoarthritis. Range of motion exercises should begin as early as possible through a formal course of physical therapy.
Multiligament knee injuries are often associated with other soft tissue and nerve damage and will generally require surgery. Direct anatomic repair is recommended if possible. Bony avulsions, where the ligament is torn off the bone and a small piece of bone with it, can be repaired by reattaching the ligament to bone. Ligament reconstruction involves removal of the damaged ligaments and replacing them with tissues grafts from another part of the patient’s body or from a donor.
Post-surgery, a hinged brace must be worn for 4-6 weeks. Early range of motion exercises are encouraged. Rehabilitation is vital to restore strength, stability, and function. Recovery from multiligament knee injuries with surgery require extended recovery and post operative rehabilitation.
Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician trained at Northwestern University and received a fellowship at the Cleveland Clinic. He specializes in the treatment of complex knee, shoulder and elbow injuries and degenerative conditions. Contact him to schedule a consultation to learn more about how he can help you return to the life you love and the activities that make life worth living. He serves teens and adults in Chicagoland and NW Indiana.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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