The knees are the largest joints in the human body; they perform crucial functions in standing, walking, running and jumping. They provide powerful thrusts and absorb tremendous shocks. Seven ligaments run in and around the normal joint, and four provide front back, inside (medial collateral ligament – MCL) and outside (lateral collateral ligament – LCL) stability. Two are particularly vulnerable to severe knee injury, the medial collateral ligament or MCL, and the anterior collateral ligament or ACL.
The medial collateral ligament is vulnerable to forces applied to the outside of the knee that stretches the inside too far open, and ACL injuries occur when force to the front of the knee expands the backside too far. The MCL runs along the inside of the knee, and it connects the thigh to the lower leg. MCL injury is common, particularly in contact sports. Doctors can treat most medial collateral ligament injuries conservatively, and they do not require surgery.
Mechanics of MCL Injury
Sudden forces are the most common source of knee injury to the medial collateral ligament. A medial collateral ligament injury can be a twist or an impact from the outside knee area. The knee forced inward bends past the point that the MCL holds the knee stable. The result is a stretching, tearing, or break of the ligament. The frequent result is a sprain of the MCL that can vary by grade from a mild stretch to a violent rupture of the ligament. A medial collateral ligament injury from a torn MCL or sprained MCL is a common knee injury, but it is nonetheless limiting and required care to avoid future complications.
- Up to 5% of isolated medial collateral ligament injuries have associated tears of the meniscus, the soft cartilage plate in the knee.
- 15% of all sports injuries involve knee injury.
- 50% of visits to sports doctors are from knee injuries, which constitute only about 15% of all sports injuries. This indicates that they are often significant and disabling injuries.
High Risk Groups
Competitive athletes in contact sports are most at risk for medial collateral ligament injury. This includes sports such as football, ice hockey, and impact activities like gymnastics and downhill skiing. Quick pivots are another leading cause, and that would include basketball, tennis, and racquet sports. However, medial collateral ligament injuries can occur in relatively easy activities such as jogging or walking when missteps cause sudden twists of the knee.
The most common symptom is knee pain, often a sudden pain at the point and time of knee injury. The knee pain includes bruising, and tenderness at the point of injury when touched. In a short time, swelling occurs and a noticeable loss of motion and flexion in the joint. Walking and standing become painful and in severe cases the joint will not bear weight.
Some factors Doctors use to diagnose and classify an medial collateral ligament injury are as follows:
Grade 1 – a mild stretching and slight tearing of the ligament.
Grade 2 – a partial tear, looseness in the joint, and damage to fibers.
Grade 3 – severe disruption or complete tear of the ligament.
The best approach to medial collateral ligament injury is relieving pain and swelling while resting the joint to allow healing. Rest, icing, compresses, and elevation of the joint works well to begin healing and stabilize the joint. Most MCL sprain injuries heal with rest and less invasive treatment than MCL surgery.
Rehab & Recovery
Treatment and recovery depend upon the severity of the knee injury and the extent of involvement with other structures such as the cartilage and meniscus. As a guideline, mild or Grade 1 sprains require rest and treatment steps as shown above in MCL Treatments. A more severe MCL tear or Grade 2 sprains require longer periods of healing, and many healthcare providers recommend a short course of physical therapy to strengthen the muscles around the joint which weaken with a knee injury and inactivity.
Knee surgery is indicated for a small number of cases usually involving Grade 3 ruptures and severe tears. Grade 3 injury does not require surgery. However, it is sometimes the best option for repairing associated damage, and regaining peak level. Some equipment can aid recovery, and many therapists recommend knee braces and leg sleeve devices for support and protection in rehabilitation. In all phases, it is vital to use footwear that provides strong lateral support.
How to Avoid an MCL Injury
Some medial collateral ligament injuries seem inevitable in contact sports; they are part of the risks athletes accept when they participate in these activities. While it may not be possible to eliminate medial collateral ligament injuries, one can reduce the risk of knee injury by following some guidelines for training, exercise, and using equipment. Another factor that plays a crucial role in avoiding injury is following proper nutrition through diet, as well as taking joint supplements that ensure healthy joints, and that can help to strengthen tendons and ligaments.
- Since the risk of medial collateral ligament injury rises with sharp increases of exercise, one should avoid sudden increases and raise activity in small steps to reach a peak level.
- Use proper techniques in training and participation in sports, many sports rules and training requirements provide protection against knee injury when followed.
- Footwear is an essential source of protection, and one must wear shoes that help the knee remain stable. The correct amount of friction is essential; the shoes should be designed for the typical exercise or playing surfaces.
Range of Motion and Flexibility
Prior to exercise or participation in sports, one should stretch and warm-up the knees. Some combination of half-squats, side squats, and front and back lunges work well. The seated knee hugs are excellent, and one flexes each knee by gripping with two arms.