MCL Sprain (Medial Collateral Ligament)

What is the MCL (Medial Collateral Ligament)

Medial cruciate ligament PCLThere are four ligaments that hold your knee in place.  The ACL, PCL, LCL, and MCL.  If you were to stand up straight and touch your knees together then you would locate about where your MCL is located on each knee.  The Medial Collateral Ligament starts on your femur, in between your legs, and attaches to the lower leg bone called the Tibia.  Part of this ligament attaches to the meniscus cushion in between the knee bones, inside the knee joint.  Often if the MCL is compromised then the meniscus and/or ACL may also be compromised.  A large amount of force would have to be applied to the outside of the knee, separating the upper leg from the lower leg at the knee joint with one, or both, of the bones being pushed inward with force beyond which the ligament can handle.

Types of MCL (Medial Collateral Ligament) Sprains

All sprains are divided into grades, and the MCL is no different.  For MCL Sprains three grades of I, II, and III, are used to classify the injury.  Unfortunately, all three grades of sprains painfully swell preventing the extension or bending of the knee joint

Grade I Medial Collateral Ligament (MCL) Sprain

A grade I MCL Sprain would be with no or only slight tearing of the MCL.  In this type of sprain the ligament is stretched beyond what it is comfortable with and will become inflamed, causing loss of range of motion and pain.

Grade II Medial Collateral Ligament (MCL) Sprain

A grade II MCL Sprain consists of about a 50% tear in the ligament.  The ligament is stretched past its tearing point and is partially torn.  This is going to cause large amounts of swelling, perhaps preventing movement of the knee joint in either direction, as well as significant pain.

Grade III Medial Collateral Ligament (MCL) Sprain

A grade III Medial Collateral Ligament (MCL) sprain is a complete tear, or often called a rupture.  This amount of damage is going to need surgical intervention and the knee will be swollen in a locked position and very painful.

Diagnosis of a Medical Collateral Ligament (MCL) Sprain

The first step that will be completed is a physical examination.  Athletic trainers, which are present at many sporting events at high school levels and above, have about a 90% accuracy from on field examinations.  If you are an athlete, or just one of the rest of us, a athletic trainer, or doctor, will perform a physical examination of the knee.  A Valgus stress test will be used to identify a MCL injury by exposing medial knee instability or pain.  X-rays can be used to determine if any bone was damaged in the high energy impact, but a MRI will be needed if confirmation of the extent of damage is needed.

Treatment of a MCL (Medial Collateral Ligament) sprain

Generally a grade I or grade II MCL sprain can be treated conservatively.  Grade III sprains will need the consideration of surgical intervention.

Conservative treatment of an MCL (Medial Collateral Ligament) Sprain

knee brace for MCLConservative treatment of a MCL sprain is going to be appropriate for grade I & II sprains.  The patient will need to be non-weight bearing with crutches until they can walk without pain.  After they can walk without pain, or limping, then a physical therapy regimen can be started to regain flexibility and strengthen the knee.  It may be recommended that the patient wear a hinged knee brace to prevent lateral movement of the knee while it is destabilized.

Surgical treatment for a MCL (Medial Collateral Ligament) Sprain

Grade III sprains can indicate surgical intervention with a open surgery to reconstruct the medial collateral ligament (MCL).  The reconstruction can use allograft or autograft, fancy words for donor tissue or your tissue, and will result in long recovery.  Recovery is about a year long process with the first 6-12 weeks completely immobilized with the knee bent.  A device will ensure compliance while the tendon graft heals.  Crutches or a scooter may be used for mobility during this recovery.  Physical therapy will be utilized and over time the knee will be straightened until full range of motion is achieved without tearing the graft.  Rehabilitation of the leg will be necessary to regain full range of motion and proper leg strength.

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