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A Medial Collateral Ligament (MCL) injury is a tear or sprain to the band of tissue on the inside of the knee. The MCL connects the thigh bone to the lower leg bone. It provides stability throughout the leg and prevents the knee from bending inwards. When injured, this stability is reduced, but the first signs of an MCL knee injury will usually be localised pain and swelling.
The three bones which meet to form a knee joint all need to be perfectly aligned, connected and balanced. The thigh bone (the femur), the shin bone (the tibia) and the kneecap (the patella) are all connected to each other by ligaments. There are four ligaments that complete this circuit. They provide a flexible and strong connective bridge which keeps the knee stable and allows the knee joint take the weight of the person. When any of these ligaments are injured, this function is compromised.
Medial Collateral Ligament injuries are not common in everyday life. The kind of movement needed to tear or sprain the MCL is mostly encountered when doing sports or vigorous activities. The most common cause of injury is the strong force of an impact that pushes the knee sideways. This could be from forceful contact, as in football when a player in motion strikes the outstretched leg of another player, or in skiing when the speed of an impact can cause the injury.
In contact injuries, MCL tears occur from a direct blow to the outer side of the knee that pushes the knee inwards. Alternatively, a blow landed on the inside of the knee that pushes the knee outwards can result in lateral collateral ligament injuries (LCL), which are more common. Generally, internal blows only cause an MCL injury when an LCL injury is also suffered.
In non-contact injuries, bending, twisting, compressing, jumping and quick changes of direction can all cause MCL injuries. This makes MCL injuries a common injury in sports like skiing and parkour, cross-country running and obstacle-course disciplines as well as in wrestling, hockey, and rugby. Any sports where participants need to use stop-and-go movements, jumping, leaping and weaving will pose a risk of MCL injuries.
The quick answer is that MCL injuries are fairly common in certain sports and to certain people. In an 11-year study by the Union of European Football Associations (UEFA), MCL sprains accounted for 7.9 per cent of all injuries that needed attention. In a similar study on American high-school sports, the authors found that female participants playing the same sports as male participants suffered more MCL tears. MCL injuries also become more common at higher levels of a sport.
The knee is the largest joint in the body and carries an enormous amount of weight. When the MCL is injured, walking becomes difficult, painful or impossible, depending on the severity of the injury. Injured ligaments are referred to as sprains but include what doctors consider sprains and tears.
The first level of injury is a Grade 1 sprain. This will result in soreness or pain and some swelling, but there is no loss of function aside from the side-effects of pain when walking. In this injury, the ligament has been slightly over-stretched and recovery is needed.
Grade 2 sprains are also painful. However, now the ligament has been stretched far enough to become loose. There is a loss of function, and the knee will feel wobbly. Doctors will often refer to this injury as a partial tear of the ligament.
The severest MCL injury is a Grade 3 sprain, frequently referred to as a complete tear. When this injury occurs, the ligament is split in two. This leaves the knee joint completely unstable and unable to support the weight of the person.
If there is pain on the inside of the knee, towards the other knee, the sprain could be a Medial Collateral Ligament injury. Any loss of function should be reason enough to visit a doctor or physiotherapist.
During your consultation, your doctor will likely ask about symptoms and how the injury occurred. A physical examination of the injured knee compared to the non-injured knee is a good guide to judging MCL injuries. Your doctor may order X-rays if her or she suspects some bone damage, but X-rays can’t identify MCL injuries.
Magnetic Resonance Imaging (MRI) scans can check for soft-tissue injuries, but these are expensive and only usually necessary for professional sports persons. However, if recovery is slow and surgery is suggested, an MRI can be used to check the tissue beforehand.
While the injury is recent, cold packs or crushed ice placed in a plastic bag and wrapped in a towel can be used to bring down swelling. The compress should be applied for 15 minutes and then taken away for one hour and then reapplied. This can be carried out all day or until the swelling has stopped.
After a visit to the doctor or physiotherapist, a brace might be recommended to add stability and to protect the knee from sideways forces or over-stretching. A brace can allow someone with an MCL injury to go about their usual routine - for example, to go to work or school while the injury is recovering. For grade 2 or 3 strains, a pair of crutches can help take the weight off while walking.
Most important to the recovery process is physical therapy. Non-contact MCL injuries often happen when someone is over-estimating the current strength or flexibility of the knee. Specific training will recondition function to the knee and strengthen the muscles that support the knee and ligament.
Occasionally, an MCL injury will require surgery. This can be the case when a grade 3 doesn’t respond to physio or a ligament is injured in such a way that it cannot heal unaided. Using stitches, bone staples, medical screws or a suture anchor, your surgeon will reattach the two sides of the ligament together to allow it to heal. MCL surgery is relatively straightforward and results in a small scar on the inside of the knee.
After an injury has healed, your doctor will allow a gradual progression back into playing sports. Depending on the severity of the sprain and how well it healed, they may suggest a brace is worn during sports.
The good news is that a straightforward MCL injury usually heals quickly. This means a grade 1 injury can be fully healed in two weeks and a grade 2 within a month. Even a grade 3 can heal within eight weeks. If surgery is needed, eight weeks to three months will usually be all that is a full recovery. However, if a relapse occurs during recovery, this will mean a longer recovery time.
Naturally, after suffering an MCL injury, the thought of it re-occurring is an unpleasant one. MCL injuries do re-occur, but there are reasons why this happens.
If someone returns to sports before the injury has fully healed, a relapse can occur. This might mean the damage is greater and the grade higher, as the stability of the knee was already compromised when the new injury occurred. Likewise, if the original injury occurred due to a weakness in the leg muscles and these were never strengthened, then the injury can happen again. It can also be that the person has a functional or physical issue that makes them prone to the injury.
The first step should be to ensure a full recovery has taken place before returning to sports, but this is sometimes easier said than done. A week off from sports can be manageable, but any time longer than two weeks will see a decrease in physical condition.
Alongside a good rehabilitation program and physiotherapy, there are things you can do to prevent a re-occurrence while you progress back into sports. By using a physiotherapist-approved brace, sportsmen and women can protect against repeat injuries and remind themselves of their existing injury. There is a wide selection of braces which use different mechanisms to support the knee, encourage strengthening and even simply remind the wearer of their obligation to their healing knee. As with many physical injuries, being aware of the injury and responding to it appropriately can be half the battle in regaining 100% functionality and stability.