The MCL is the most injured knee ligament, especially in young athletes. An MCL tear may be an isolated injury or occur in combination with other knee ligaments, especially the anterior cruciate ligament.
The medial collateral ligament (MCL) and the lateral collateral ligament (LCL) in the knee are the primary restraints to side-to-side knee movement. The MCL is located on the inside of the knee. The LCL runs on the outside of the knee. These collateral ligaments attach the end of the femur (thighbone) to the top of the tibia (shinbone)and control side to side motion of your knee. The collateral ligaments work with the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL)to stabilize the knee.
What causes an MCL injury?
MCL tears are caused by trauma during popular sports like soccer, skiing, and ice hockey. An MCL tear is commonly caused by a direct blow on the outside of the knee, or by cutting maneuvers when planting the foot and suddenly shifting direction or speed.
Grading MCL injuries
MCL injuries are graded on a scale from 1 to 3, with grade 1 being a mild injury (also called a sprain), grade 2 being a moderate injury (a partial tear), and grade 3 being a complete tear of the ligament. With a grade 3 MCL tear, the ligament has been torn in half or pulled directly off the bone leaving the knee joint unstable. Treatment depends on the severity of the injury. The good news is that because the medical collateral ligament has a high healing capacity it can often be treated non-operatively unless there is damage to other knee ligaments that requires surgery.
What are the symptoms of an MCL tear?
An MCL tear may cause the following symptoms:
- pain and tenderness on the inside of the knee
- swelling, bruising and stiffness
- hearing or feeling a pop
- knee instability or “giving way” sensation with a grade 2 or 3 injury
- decreased range of motion in the knee joint.
How is an MCL tear diagnosed?
Immediate treatment is important to reduce swelling and tenderness with icing and over the counter pain medication. This will help Dr. Harrison to provide an accurate diagnosis.
Dr. Harrison will review your medical history and inquire about how your injury occurred and the symptoms you are experiencing. He will perform an orthopedic examination feeling the knee and testing knee stability and perform special tests to identify damage to other knee structures. He will also order imaging studies including x-rays to evaluate the bones and an MRI to evaluate the knee ligaments.
How is an MCL tear treated?
A majority of isolated MCL tears, regardless of severity, can be treated conservatively with rest, icing, elevation, over the counter anti-inflammatory medications, compression with bracing to protect and support the knee. Your knee must be protected from the same sideways force that caused the injury. Activity modification and bracing are commonly prescribed.
Grade 1 injuries can be managed without a brace. Grades 2 and 3 may require a hinged knee brace and may be worn up to three to six weeks. Range of motion exercises should begin at the earliest opportunity with weight bearing only as tolerated. Strengthening exercises are a focus of physical therapy.
When is surgery indicated?
If the MCL tear is part of a multi-ligament knee injury, surgery may be necessary. When the medial collateral ligament tear is combined with an anterior cruciate ligament tear, it is well established practice to reconstruct the anterior cruciate ligament and treat the medical collateral ligament tear conservatively in most cases. Postoperative rehabilitation is essential to restore function.
Contact Dr. Harrison to learn about your injury and your treatment options.
Dr. Harrison is a board-certified fellowship trained orthopedic and sports medicine surgeon who specializes in arthroscopic knee and shoulder surgery. He is the Head Team Physician for the United States Alpine Ski Team and the Head Team Physician for Weber State University for over 20 plus years. Dr. Harrison completed his undergraduate degree at Baylor University and received his medical degree from the University of Arizona College of Medicine. He completed his orthopedic residency at the University of Utah followed by a fellowship in sports medicine at the Cincinnati Sports Medicine and Orthopedic Center. He finished his formal training with an additional AO Trauma Fellowship in Bern, Switzerland.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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