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Anatomy of medial collateral ligament sprain injury

MCL Injury

The medial collateral ligament is the primary stabiliser of the inner (medial) side of the knee. It is a thick fibrous band and is designed to resist valgus (side-on) forces to the knee.

Symptoms:

Pain, swelling and instability are all common with this injury. It is possible that you will lose some joint range of motion and struggle to weight bear initially, if it is a substantial injury.

Onset:

The onset is usually traumatic and can happen via a direct blow to the outside of the thigh. Or the MCL can be torn when the foot is planted and there is a valgus strain put on the knee. This often happens in football tackling injuries. Occasionally this injury can happen when there is a valgus stress placed upon the knee in conjunction with the femur externally rotating. This type of injury often occurs while skiing.

Tears to the MCL are classified as follows:

Grade 1: Tearing of a few fibres but no ligament laxity or joint instability is present.

Grade 2: Tearing of a substantial amount of fibres, with mild ligament laxity and joint instability present.

Grade 3: A complete tear of the mcl fibres, ligament laxity and joint instability are both present

Aggravating factors:

Valgus knee forces, walking on uneven ground and changing direction sharply when running.

Easing factors:

Avoiding the aggravating factors, using ice and a supportive brace.

Management:

Most MCL injuries are successfully managed non-operatively using the principles of POLICE (protection , optimal loading , ice, compression and elevation) under the guidance of a physiotherapist. In cases where there is chronic instability or if there are multiple ligament injuries, surgical intervention may be required.

References:

Marchant, Milford H et al. (n.d.) Management of Medial-Sided Knee Injuries, Part 1: Medial Collateral Ligament. The American Journal of Sports Medicine. [Online] 39 (5), 1102–1113.

Hanley, Jessica M. et al. (n.d.) Patient-Reported Outcomes After Multiligament Knee Injury. Orthopaedic Journal of Sports Medicine. [Online] 5 (3), 2325967117694818.

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