MCL Tear

Overview

The medial collateral ligament, or MCL, is a broad, thick band that runs down the inner part of the knee, from the femur (thighbone) to a point 1.5 to 2 inches from the top of the tibia (shinbone). The MCL functions primarily to prevent the leg from extending too far inward, but it's also part of the mechanism that stabilizes the knee and allows it to rotate.

MCL injuries commonly occur when such a strong force hits the outside of the knee that it causes the MCL – and possibly other knee ligaments, such as the anterior cruciate ligament (ACL) – to stretch or tear.

This happens to people playing certain sports – in football, for example, when one player collides with another from the side. MCL injuries are also common in sports that require quick stops and turns, such as soccer, basketball and skiing. However, not everyone who damages this ligament is an athlete. Simply slipping on ice, if the lower leg splays out, can injure the MCL, as can repetitive smaller injuries that gradually cause the MCL to lose its normal elasticity and become limp, like a worn-out rubber band.

Our approach to MCL tears

UCSF is committed to helping patients with MCL tears return to the highest level of activity possible, whether that means a daily walk or reporting for practice with the NFL. Our team includes orthopedic surgeons, primary care sports medicine doctors, physical therapists and athletic trainers. These specialists work together to tailor a treatment plan to each patient's needs and goals.

Most MCL injuries can be healed through physical therapy. We offer the full range of these treatments, including exercise regimens, functional activity training and neuromuscular reeducation (techniques that condition the area to move normally again). Our specialists guide each patient through a personalized program designed to facilitate healing, recover function and improve physical performance.

Signs & symptoms

An MCL tear produces symptoms along the inner side of the knee (toward the midline of the body). Initially, you may experience:

• A pop on the inside of the leg
• Tenderness or pain that ranges from mild to severe
• Stiffness
• Swelling
• Unsteadiness, locking or catching in the joint

Diagnosis

Your doctor will likely ask how you injured your knee, how it has felt since the injury and whether you've injured it before. An exam will include checking for pain or tenderness along the inside of the knee and checking the integrity of your MCL by exerting pressure on the outside of your knee while your leg is both bent and straight.

Depending on the degree of pain or looseness of your knee joint, the injury will be classified as one of three grades:

• Grade 1. There's some tenderness and minor pain at the point of injury.
• Grade 2. There's noticeable looseness in the knee ("opening up" approximately 5 millimeters when manipulated), major pain and tenderness at the inside of the knee, and (in some cases) swelling.
• Grade 3. There's considerable pain and tenderness at the inside of the knee, along with some swelling and marked joint instability (the knee opens up approximately 10 millimeters when manipulated). A grade 3 MCL tear often occurs in conjunction with an ACL tear or, more rarely, with a tear in the posterior cruciate ligament (PCL).

In some cases, the immediate pain and swelling interfere with the doctor's ability to accurately gauge the injury's severity. If this is your situation, you may be asked to wear a light brace, apply ice and elevate your knee; in time, the swelling and pain will lessen enough to allow diagnosis.

In addition, your doctor may order the following tests:

• X-ray. This can show other damage and bone injury.
• Magnetic resonance imaging (MRI). This test is 90 percent accurate for diagnosing MCL injuries and may be ordered if the physical exam findings are unclear or if your doctor suspects other injuries.
• Stress X-ray. This test is similar to a regular X-ray, except the doctor or technician holds the knee open from the side so that any widening of the joint space will be evident on the image.

Treatments

Nonsurgical methods

Recovery time for an MCL injury depends on the severity of the damage. On average, these injuries take six weeks to heal. No matter the grade of the tear, initial treatment focuses on immobilizing the knee and reducing pain and inflammation. Measures include:

• Resting, icing and elevating the knee
• Taking oral medications that relieve pain and inflammation, such as aspirin and ibuprofen
• Wearing a brace that allows the knee to bend while restricting side-to-side movement

Some knee braces are designed to prevent bending. In that case, you'll need to modify your activities so that you don't have to squat, kneel down or bend over. Try to keep your leg elevated, even when you're sitting, to bring down the swelling.

Once the pain and swelling subside, you'll begin a physical therapy program, which will include exercises to restore strength and normal range of motion. If your knee feels sore while doing these exercises, proceed slowly to prevent further irritation and consult your physical therapist.

Depending on the injury's severity, these methods – a period of rest, bracing and physical therapy – usually suffice to heal the tear. However, if the torn ligament doesn't heal sufficiently, you may experience instability and be more susceptible to reinjury. Surgery may be required in rare cases.

Once the MCL has fully healed, you should have minimal long-term effects, provided your knee suffered no other damage.

As previously noted, recovery times vary widely, but in general:

• A grade 1 (minor) MCL tear can take from a few days to a week and a half to heal enough for a return to normal activities, including sports.
• A grade 2 tear can take from two to four weeks to heal.
• A grade 3 tear usually takes four to eight weeks to heal, unless the ACL is also damaged, in which case recovery may take longer.

Surgical methods

While most MCL injuries can resolve without surgery, there are instances where surgery is the best treatment option. The surgery will either repair or reconstruct the MCL. To repair the ligament, your surgeon will make an incision at the torn area and use fixation devices called suture anchors to secure the ligament back to the bone. To reconstruct the ligament, your surgeon will use tendons from either your knee or a cadaver knee.

With either surgery, you can probably return home the same day. After surgery, you'll use crutches and a knee brace for about six weeks. At a post-op visit one to two weeks after surgery, your doctor will check your knee and remove the stitches. Recovery time depends on any related knee injuries but is generally between nine and 12 months.