What is a medial collateral knee ligament sprain?
A medial collateral· ligament (MCL) sprain is a tear of the soft tissue ligaments on the media (inside) of the knee.· The MCL is one of the four ligaments (soft tissue structures that connect bones in the knee and the most commonly injured one. The MCL is a structure that helps keep the normal relationship of the femur (thigh bone) and the tibia (leg bone) along the inner side of the knee. The MCL prevents the knee from buckling inward and is the ligament most commonly injured in sports. When torn, this ligament usually heals. Occasionally, however, especially when associated with other ligament injury, it may heal in a lengthened position, making the knee slightly loose.
Sprains are classified into three grades
1.···· In a first-degree sprain the ligament is injured,· but there is no· significant tearing of the fibers and no loss of overall integrity
2.···· In a second-degree sprain, the ligament is torn such that many but not all fibers are disrupted.· The ligament is still intact overall
3.···· In a third-degree sprain, the ligament is completely torn and has lost its overall integrity. Most MCL sprains occur in the mid-portion, though they can occur at their origin (on the femur) or insertion (tibia)
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How does an MCL sprain occur?
MCL sprains occur when a sudden force exceeds the strength of the ligament.· This most commonly occurs when one is hit on the outside of their knee, such as when being tackled in football.· Less commonly, the ligament can be injured when a player’s foot remains in the contact with the ground (such as when a cleat is dug into the turf) and he or she cuts in the opposite direction.
What increases risk?
- Contact sports (football, rugby) and sports that require pivoting and cutting (sudden change of direction), such as soccer and baseball
- Poor physical conditioning (strength and flexibility)
What are the symptoms of an MCL sprain?
- A popping, tearing or pulling sensation noted at the time of injury
- Pain and tenderness on the inner aspect of the knee
- Swelling and bruising (after 24 hours) at the site of injury
- Knee stiffness
- Difficulty with walking
How is an MCL sprain diagnosed?
Diagnosis is made by the appropriate history and physical examination.· Physical examination shows tenderness along the MCL.· Tenderness can sometimes be limited to the bony origin on the medial epicondyle of the femur or the tibial insertion on the tibia.
Most of the time however, MCL sprains affect the mid-portion of the ligament, and there is diffuse tenderness over its course on the inside of the knee.· Examination may also show laxity that is not normally present when the MCL is normal.· Laxity occurs when stress is applied to try to “open up” the knee, determining the amount of the knee laxity and quality of the end point.· Everyone has a different degree of soft tissue “play,” so comparison to the opposite knee is of value.
Are there any special tests?
X-rays are usually of very little value because, with few exceptions, this is a soft tissue injury.· Only soft tissue imaging studies can confirm and assess the extent of the tear. MRI (Magnetic Resonance Imaging) is the best imaging test for assessing integrity and injury of this ligament, as well as excluding other conditions that may present with medial knee pain.
How is an MCL sprain treated?
Sprains of the MCL, even complete disruptions, are usually treated without surgery.· Because the ligament is “extra-articular,” the initial inflammatory response and migration of healing cellular and vascular elements can effectively form a scaffold at the site of the tear and act as· the reparative process.
Initial treatment consists of medications and ice to relieve pain and reduce knee swelling. Crutches may be necessary to help bear weight until you are able to walk comfortably.· Sometimes these are necessary for a week or more.· Your physician may recommend a hinged knee brace to protect against stresses while the ligament heals.· Range-of-motion, stretching and strengthening exercises may be carried out at home, although referral to a physical therapist or athletic trainer is usually recommended. Rehabilitation of MCL sprains generally concentrates on reducing knee swelling, regaining knee range of motion, regaining muscle control and strength, and a short period of bracing.
Surgery is very uncommon.· Most studies have demonstrated comparable outcomes in those patients subjective to either non-operative treatment or surgical repair.· Exceptions to this rule are third-degree complete tears off the bone, which, when associated with some other significant ligament injury (most commonly a tear of the ACL or Anterior Cruciate Ligament), probably deserve surgical consideration.
What are the complications of treatment?
Possible complications of non-operative treatment include:
- Lengthy convalescence in order to return to full activity
- A small number of third-degree sprains will fail to tighten up, with some mild residual laxity that may be noticeable to some patients.
Possible complications of operative treatment include:
- Failure of the repair, such that the ligament remains slightly lax
- Gradual stretching of the repair, especially in presence of other ligament injury or abnormal alignment
- Prominent hardware, in which the screw or staple or other device used to fix the ligament to the bone, may be palpable (felt) or visible to the patient
- Surgical complications not specifically associated with the knee, including pain, bleeding (uncommon), infection (<1 percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity
When can you return to your sport or activity?
Timing depends upon the severity of the sprain, the athlete, and the intensity of the activity to which they are returning. For example, a minor first-degree sprain may permit return to football or hockey in just a few days to a week.· In comparison, a third-degree injury may mean you're unable to participate for a six to eight week period.· Certainly one must have achieved full range of motion, good strength, and have no tenderness or laxity along the medial side of the joint.
How can an MCL sprain?
- Appropriately warm up and stretch before practice and competition
- Maintain appropriate conditioning:
- Thigh, leg, and knee flexibility
- Muscle strength and endurance
- Cardiovascular fitness
- Wear proper protective equipment (such as the correct length of cleats for surface)
- Functional braces may be effective in preventing injury.· These are commonly used prophylactically by football lineman.· They may be of value following previous injury when returning to sport