Knee Medical Collateral Ligament (MCL) Injury
The medial collateral ligament (MCL), a band of tissue present on the inside of your knee joint, connects your thigh bone and shin bone (bone of your lower leg). The MCL maintains the integrity of the knee joint and prevents it from bending inward.
Your MCL may get sprained or injured while twisting, bending or quickly changing direction. The sprain is classified into three degrees:
- First-degree sprain: Ligament fibers may be injured, but with no significant tear and no loss of integrity
- Second-degree sprain: Not all ligament fibers are torn. Ligament remains intact overall
- Third-degree sprain: Complete rupture of ligament and loss of overall integrity
MCL sprains occur due to sudden impact from the outside of your knee, most commonly while playing sports such as rugby and football. Rarely, the MCL can get injured when the knee gets twisted or following a quick change in direction. Anterior cruciate ligament (ACL) may be torn along with a MCL injury.
The symptoms of MCL sprain include:
- Tenderness and pain in the inner side of the knee
- Swelling and bruising
- Stiffness of knee
- Difficulty walking
Your doctor will review your symptoms and medical history. Physical examination will be performed where your doctor checks the range-of-movement of your legs. An X-ray or MRI scan may be ordered to determine soft tissue injury, confirm the extent of damage, and assess the integrity of your knee.
MCL sprains are commonly treated by conservative procedures. You will be advised to take adequate rest and not to strain yourself. An ice pack may be applied for 10 to 20 minutes for every 1 to 2 hours to reduce swelling. You may be prescribed anti-inflammatory medicines to reduce the pain and swelling. Your doctor may recommend crutches and braces to support, protect and limit movement in your knee. Rehabilitation procedures and exercises for MCL sprains generally focus on regaining knee range-of-motion, muscle control and strength, and reduce swelling. Surgery is performed very rarely, in case of significant third-degree ligament injury.
Based on your extent of damage, your doctor will suggest the best possible treatment option to treat your MCL sprain.
Medial Collateral Ligament Tear in Adults
Patients with an MCL tear have symptoms such as knee pain, swelling, and locking or catching sensation in the knee during movement. Patients may also feel as though their knee may 'give out' suddenly or buckle.
Your doctor will usually diagnose an MCL injury based on a physical examination of your knee. To determine looseness of the ligament, an MCL test may be performed by exerting pressure on the outside of your knee while your knee is bent to 25 degrees. In addition, other tests such as knee joint X-rays and MRI scan may be done.
Treatment options include non-surgical and surgical treatment. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. A knee brace may be worn to help immobilize your knee. Use of crutches may be recommended to protect your knee and to keep you from putting weight on your knee while walking. Physical therapy exercises may be recommended to improve knee motion and strength.
Most often, surgery is not necessary for the treatment of an MCL tear. If needed it is usually performed using arthroscopy. In many cases, this injury cannot be prevented. However, using proper techniques during sports or exercising can help prevent injury.
Medial Collateral Ligament Tear in Children
Medial collateral ligament tears are less common in children. Most often, it occurs in teenage athletes who participate in sports, such as football and ice hockey. Younger children below the age of 12 years are less likely to injure their MCL, as in them, the bone where the ligament attaches may break.
The skeletally immature knee in a child slightly differs from the adult knee and may result in mild variations of injury patterns. In children, the epiphyseal plates (growth plates) are weak compared with ligaments in the adults. Growth plate also called the epiphyseal plate or physis is the area of growing tissue made up of cartilage (rubbery material) found at the ends of the long bones in children. Therefore, any extraneous force on the knee causes physeal injury rather than the ligament injury. Hence MCL injuries are less common in children.