JoLynn Leisinger

MSAT 6500
Medial Collateral Ligament (MCL) Injury
One of the most common sports injuries is a medial collateral ligament (MCL) tear.
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There is usually more stress put on the MCL and this is why you see this injury often. It is easier
to get a force put on the outside of the knee than the inside of knee which in return stretches
the MCL and can then result in injury. Usually when you see an MCL injury you can also see
meniscus tears, and anterior cruciate ligament (ACL) tears. This is called the unhappy triad.
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The structure that is injured in an MCL tear is the medial collateral ligament. This
ligament connects the tibia and the femur. The MCL and the LCL work together to help keep the
knee stabilized. They are called collateral ligaments because there is one on each side of the
knee and they are parallel to each other. They help from preventing the knee from going into
overextension from side to side.
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The MCL keeps the knee from bending too far inward as well.
The MCL can also be called the tibial collateral ligament.
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It is considered to be the largest part
of the medial knee. It has two attachments to the tibial and one attachment to the femur.
There are two parts of the MCL the deep MCL and the superficial MCL. The superficial MCL
restrains the valgus force (force pushing towards the inside) on the tibia it also stops external
rotation of the tibia.
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The superficial MCL attaches to the medial epicondyle and the distal end
of the femur.
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The deep MCL is the short ligament that provides restraint of external rotation of
the tibia when the knee is flexed more than 30 degrees.
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It is also closely related to the medial
meniscus.
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Tearing of the MCL is such a common injury because it can happen doing many things.
These things that could have an impact on the MCL are bending, twisting or a quick change in
direction. There can also be a direct force put on the outside of the knee pushing towards the
inside of the knee.
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This in return stresses the inside of the knee and the MCL. This is called a
valgus force. Usually if the foot is planted and there is a valgus force this results in injury of the
MCL.
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There also can be a valgus force with external rotation of the tibia which can result in
injury to the MCL.
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Some sports that use these movements most often include soccer, skiing,
football and any sports that have the stop and go feature.
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There are three degrees of tears.
The first degree is when the ligament stretches beyond its limits causing pain, but there is no
tear. The second degree is a slight tear but is not fully torn and then finally the third would be a
full tear of the ligament. Usually when one has a full tear of the MCL there is a tear in the ACL
and meniscus damage.
The risk factors for MCL injuries include if the athlete or patient has had a previous knee
injury to the medial side of the knee. One of the biggest risk factor of getting MCL injuries is the
sport that the athlete plays. If it is a sport that includes side to side motion they are more likely
to sustain an MCL injury. The athlete can also have high laxity in the joint causing more
movement and making it easier to obtain an MCL injury.
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Like earlier stated an injury to the MCL are very common in many different sports.
Participants in sports have rose immensely this is why we are seeing more injuries. According to
research around 42% of injuries are injuries that happen in the knee.
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They are also considered
to be 17.6% of all athletic injuries.
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The most common injury is the ACL and then the medial
meniscus and finally the MCL. The MCL is more likely to be injured and happens 7 times more
than lateral collateral ligament injuries (LCL). MCL tears result in 60% of the knee injuries in
skiing. Skiing and soccer are two sports that see high incidence of MCL tears. The most common
ages to see knee injuries are between the ages 20-29.
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They are also seen in younger athletes
and are more common in males than females.
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On average there are around 74,000 medial
knee injuries per year.
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An athlete or patient that experiences an MCL tear will have pain and swelling on the
inside of the knee. Most often they will feel an instability when doing a side to side movement.
This would be during the activities during cutting and pivoting. When evaluating an athlete or
patient for an MCL tear you would look for swelling and see if they are experiencing pain in the
inside (medial) of the knee.
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This would count as a visual examination of the knee. Then the
knee should be palpated to see where the patient or athlete is experiencing the most pain. In a
lot of cases one would not be able to palpate a firm end point when there is an MCL injury. The
next test that can be performed is a valgus test. This test would place a valgus force on the knee
straining the medial side of the knee. This should be done at 0 or full extension of the knee and
30 degrees.
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There is also a test called the Swain test. This test looks at chronic injury and
rotational instability. During this test the knee is put into flexion of 90 degrees and the tibia is
brought into external rotation. If there is pain along the medial knee there could be an MCL
injury.
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This is so the deep and superficial MCL gets tested for injury. Commonly the American
Medical Association Standard Nomenclature of Athletic Injuries is used when it comes to knee
injuries. This states that with a first degree the pain is localized and can be described as
tenderness. There also is no laxity seen. With a second degree tear there is localized tenderness
and there may be slight laxity seen. With the third degree sprain the tear shows laxity when a
valgus stress is placed on the knee and there is localized pain.
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They can also use magnetic
resonance imaging (MRI) to see the tear of the MCL. It will show how bad the tear is, if it is a
complete tear or a partial tear.
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Imagining is used and highly reliable when it comes to an MCL
injury. The accuracy of the imagining tests is around 87%.
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Depending on the grade of the injury the treatment differs. It also depends on the
athletes future. The grade one tear can usually be treated at home. It requires sufficient rest,
usually takes one to three weeks to heal and up to 3 months to fully return to sport. To help
this healing one can use ice, crutches, a brace and anti-inflammatory medicine. Grade two MCL
injury takes a little longer to heal, around one or two months. During this time a brace is
commonly worn so there is limited amount of weight put on the knee. The third grade can take
up to a couple of months to heal and can be seen jogging and participating in their activities
after three months.
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The patient is usually non weight bearing for a month or so. The first step
is to control the pain and swelling of the knee.
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If the MCL tear happens with an ACL injury or a
meniscus injury they usually do surgery. However if it is solely the MCL that is injured they dont
because it is a highly vasculized area and heals on its own in a good amount of time.
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During
the injury one must also do strengthening exercises and range of motion exercises. These
exercises with help strengthen the athletes hamstrings and quadriceps muscles.
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Early
rehabilitation is very important when dealing with an MCL injury. The sooner the patient can
start range of motion activities and do weight bearing activities pain free the sooner they can
return to sport.
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If surgery is done there is a cut on the femoral attachment of the MCL and the
surgery is done to fix the injuries. This can be done using stitches, bone staples or metal
screws.
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The patient usually is on crutches for the first four weeks and uses a knee brace. The
knee brace limits how far the knee can go into extension. The patient should slowly add range
of motion exercises and start strengthening the quadriceps. After surgery it can take between
6-10 months to get back to full activity.
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There are many ways to help prevent an MCL injury. These include training for the
specific sport and strengthen the muscles around the knee. Having proper equipment and
having it fit right. There are also braces that can be worn to help prevent the injury.
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Seen how
MCL injury is so common we need to think ahead of time to prevent this type of injury. An MCL
injury is easy to maintain if it the only injury and is not accompanied with the ACL and medial
meniscus. The come back from an MCL injury is very likely and does not take as much time as
some other injuries that occur in sport.

Bibliography
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