by Alan Jordan
Structure:
The medial collateral ligament (MCL) of the knee is a 10-12cm long structure situated on the inside of the knee formed of collagen fibres. The tensile and elastic properties of ligaments are important to stabilise joints (bone-to-bone) but also allow movement. The MCL protects the knee from valgus stress – outward movement of the tibia – shin bone. There are two portions to this ligamentwhich give stability in different knee positions.
Injury:
Injury usually happens when trauma is received to the outside surface of the knee causing excessive tensile force to the inner knee. An example of such injury would be a tackle by an opponent from the outside of the knee while the foot is planted down to the ground.
MCL injuries are usually graded 1-3. A Grade 1 is usually a minor sprain with a few fibres damaged. There is usually tenderness over the area. Some bruising may become visible. A Grade 2 is usually a more severe sprain with a multitude of fibres damaged, but not a complete tear of the ligament. There may be swelling and bruising associated with the injury. Some level of joint instability may be experienced. A Grade 3 injury involves a full rupture of the thickness of the ligament. Although it may be less painful than a Grade 2, bruising and swelling is usually noticed. The knee would feel unstable and may give way on weight bearing.
Management:
PRICE: Protect, Rest, Ice, Compression & Elevations
As soon as an injury occurs, the above acronym PRICE should be remembered. Physical examination would note swelling, bruising, range of movement and stability through a variety of clinical tests. X rays would not show any soft tissue damage but any associated fractures would be identified. MRI can show both soft tissue and bone structures and is the modality of choice when possible. Especially to identify any associated damage to the medial meniscus and ACL (anterior cruciate ligament). A brace may be prescribed for a number of weeks depending on the extent of damage.
Conservative treatment would include:
- limiting further damage
- control the inflammatory response
- manage the pain
- improve range of movement at the appropriate time
- strengthening muscles supporting the knee joint
- improve proprioception (joint special awareness) & balance
- and finally do sports specific rehabilitation and gradual introduction of sporting activities.
Physiotherapists at Broadgate Spine & Joint clinic would assess the injured knee and advise whether medication is required and also give you the time-frame of recovery. Should you require radiological examination we can refer for MRI scans or X rays at a facility 5 minutes away from our clinic. Onsite consultants are also available in case further intervention is required.
