What is Medial Collateral Ligament (MCL) Injury?
The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).
The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The MCL resists widening of the inside of the joint, or prevents “opening-up” of the knee.
Because the MCL resists widening of the inside of the knee joint, the ligament is usually injured when the outside of the knee joint is struck. This force causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of “clipping” in a football game.
An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus, may be torn along with a MCL injury.
Symptoms of a MCL Ligament Injury
The main function of the medial collateral ligament is to prevent the knee from hyper-extension inwards and allow rotation to happen. However when the MCL is overstretched due to trauma, it can tear quite easily. A tear to the MCL can be on its own but it is more commonly in conjunction with a tear to the ACL and meniscus.
The first symptom following an injury to the MCL injury is pain. Pain will be quite severe over the inside of the side of the knee where the MCL is located. Swelling will be evident and bruising may occur a few days after the MCL injury. In serious cases of MCL injuries, you may even experience shakiness of the knee and feel like the knee is unable to take your body’s weight and is giving way.
There are 3 different grades of MCL injury ranging from grade 1 to grade 3.
In grade 1 MCL injuries, the MCL is merely injured and is not torn. As such, symptoms are pretty mild with swelling, bruising and pain being the most common ones. Most patients are able to return back to sports within a few weeks.
In grade 2 MCL injuries, the MCL is still not torn but injury to it is much more extensive. Symptoms of instability will occur in grade 2 injuries and the pain will be much more compared to grade 1. This usually occurs during high speed sudden turning when the foot is still stuck to the ground while the knee is attempting to change direction. Nearly one month worth of recovery time is required to recover from a grade 2 MCL injuries.
A grade 3 MCL injury is the worst. It implies a complete tear of the MCL and sometimes, tears to other ligaments such as the ACL and meniscus will accompany it. Pain will be quite unbearable and the knee will be very unstable and will seem unable to take the body’s weight. A knee brace will be required to provide additional support and if other ligaments are torn as well, it will complicate thing and surgery will be the most viable option.
Knee ligaments are crucial in the stabilisation of our knee joint and allow us to carry out our daily motion without any hindrances. A MCL injury will have a negative impact on it and will cause us to have difficulties doing even basic things.
The most common symptom following an MCL injury is pain directly over the ligament. Swelling over the torn ligament may appear, and bruising and generalized joint swelling are common 1 to 2 days after the injury. In more severe injuries, patients may complain that the knee feels unstable, or feel as though their knee may ‘give out’ or buckle.
Symptoms of a MCL injury tend to correlate with the extent of the injury. MCL injuries are usually graded on a scale of I to III.
Grade I MCL Tear
This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 1-2 weeks of play.
Grade II MCL Tear
Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 3-4 weeks of rest is necessary.
Grade III MCL Tear
A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
Treatment of MCL Tear
Treatment of an MCL tear depends on the severity of the injury. Treatment always begins with allowing the pain to subside, beginning work on mobility, followed by strengthening the knee to return to sports and activities. Bracing can often be useful for treatment of MCL injuries. Fortunately, most often surgery is not necessary for the treatment of an MCL tear.
At the Singapore Sports and Orthopaedic Clinic, our orthopaedic specialists are ready to help you get back to the activities you know and love. Call us today for an appointment @ +65 9734 3087 to get a professional assessment of your condition & start your journey toward a better life!