Medial collateral ligament (MCL) tears
The medial collateral ligament (MCL) is on the inner side of the knee and helps to keep it stable by preventing the knee from buckling to the side.
The injury is often painful and can cause a stiff knee that feels unsteady in the first few days.
It is critical to get it assessed by a physiotherapist or orthopaedic surgeon as soon as possible with an MRI scan. Even if it doesn’t require surgery, the best results from rehab come from starting the recovery early which may include wearing a brace.
The medial collateral ligament (MCL) is on the inner (medial) side of the knee and is composed of deep and superficial components.
The ligament’s main job is to prevent the knee buckling outwards, but it also stabilises the knee in some movements such as certain twisting movements.
The knee joint is made up of three bones – the thighbone (femur), shinbone (tibia) and kneecap (patella) – and is stabilised by four main ligaments.
The anterior and posterior cruciate ligaments (ACL and PCL) sit in the middle of the knee and control its back and forth motion, stopping it from giving way. The medial and lateral collateral ligaments (MCL and LCL) are on the outside of the knee, resisting sideways motion and bracing it against unusual motion.
A ligament injury can be:
- Grade 1 – a sprain
- Grade 2 – a partial tear
- Grade 3 – a complete rupture
ACL injuries are usually intact or torn, rarely a partial grade 2 injury. Your specialist will grade the injury clinically – this grading may be different to the grades used by radiologists in their MRI scan reports.
MCL tears occur when the knee is forced into a position where the lower leg is angled outwards and the shin bone is rotated outwards. Injuries that involve twisting, pivoting, or stopping suddenly are more likely to result in a strain (grade 1) or partial tear (grade 2).
The most common cause is contact with another player, such as being tackled or struck to the outside of the knee. Contact injuries are usually more severe and can result in a complete ligament rupture (grade 3) along with other injuries.
If your MCL is injured and cannot hold the knee in a stable position, other structures within the knee such as the ACL and the meniscus are at risk of damage.
You may have felt your knee give way or buckle beneath you and heard a ‘pop’ as the ligament snapped. You may have felt an immediate sharp or stabbing pain directly over the inside of your knee at the time of the injury.
You may not be able to take all their weight through your knee and need support from others or crutches to walk. If you managed to continue playing on, your knee may have felt unstable or given way.
The knee will swell in the first 24 hours and can remain swollen for weeks, depending on the injury’s severity and whether other ligaments or cartilage are damaged. The swelling makes the knee stiff and difficult to fully straighten or bend.
A description is usually enough to diagnose an MCL injury. Your specialist will also ask about your general medical history and previous knee and other joint injuries. It’s important to detail your recreational and sporting activities and their competitive level – this can change your treatment options and recovery timelines.
An examination of the knee will usually demonstrate the MCL injury and any associated damage.
A specialist will always want an MRI scan to check for associated cartilage, meniscus and other ligament injuries. It is common to have an x-ray as well – this is the easiest imaging to get quickly and can rule out a fracture.
The first stage of treatment is to settle the knee down which involves treating the swelling and the stiffness. It is vital to engage a physiotherapist as early as possible. We help you to settle your knee down so that it can be used for day to day activities without pain.
This involves anti-inflammatories such as ibuprofen, diclofenac or meloxicam for 1 to 2 weeks, which reduces swelling and pain – please check with your doctor or specialist that these medicines are safe for you first. Some compression bandaging can be useful, as can ice packs.
The quadriceps muscle which protects the knee will weaken quickly without training, and the swelling will make the knee stiff. Specific exercises as part of a comprehensive prehab and rehab program aim to strengthen the surrounding leg muscles and restore knee joint function.
An MCL sprain (grade 1) rarely requires anything more than the basic rest, ice, compression and elevation (RICE) and will generally heal after a few weeks.
Treatment for more severe injuries (grade 2 and 3) can include wearing a brace to support the knee and protect the MCL from further injury. The braces used allow normal knee movement, so you can exercise with a physio and prevent any muscles weakening. Recovery usually takes 1-2 months, guided by your surgeon and physiotherapist.
Some injuries need surgery. These include:
- Multi-ligament knee injuries
- Complete ruptures mid-ligament where the ends are a long way from each other
- When an end of the torn ligament gets stuck where it can’t heal
- Ongoing instability despite non-operative management
At MTP Health we have specialty knee rehabilitation programs that are tailored to your goals and suitable for those aiming to prevent surgery or recover fully following surgery.