What is it?
A ligament is a strong, fibrous connective tissue that connects bone to bone. They help to increase the stability of the joint through limiting the movement between bones. In the knee joint, this is through restricting side to side movement of the femur (thigh bone)and tibia (shin bone) to allow the knee to move in a hinge like motion.
The Medial Collateral Ligament (MCL) is found on the inside of the knee and runs from the bottom of the femur to top of the tibia. Its role is to provide support to the inside of the knee.
Causes
The MCL is the most frequently injured ligament in the knee. MCL sprains are often caused by abruptly turning, twisting or sustaining force to the outside of the knee. A “tearing” sensation or audible “pop” may be noticed immediately during or after injury.
Common Signs and Symptoms
- Pain and/or tenderness over the inside of the knee
- Swelling
- Locking or catching with movement
- Instability and/or feeling the knee give way
- Difficulty weight bearing
- Decreased knee movement
Diagnosis
Diagnosis can be determined by a Physiotherapist who will complete a thorough subjective and objective assessment. This will involve a hand-on assessment comprising of palpation to locate areas of tenderness, range of motion, ligament testing and functional strength testing. Evidence suggests that the most accurate time to complete an assessment is immediately post-injury.
Investigations such as Ultrasound and X-Ray are not necessary for diagnosis, however, may be indicated to rule out fractures and assist in grading the degree of injury severity. The injury may be categorised as Grade I (mild sprain), Grade II (moderate sprain) or Grade III (severe sprain).
Management
Most isolated MCL injuries are able to be managed conservatively through Physiotherapy and exercise.
During the acute stage, treatment will aim to manage pain and inflammation, and restore knee movement. This may consist of:
- Equipping you with strategies or equipment such as a hinged knee brace or crutches to protect the area
- Elevating the knee above the level of the heart
- Avoiding anti-inflammatories unless at the discretion of your health provider
- Providing compression garments
- Supporting you with education around aggravating activities and self-management strategies to help you become actively involved in your rehabilitation.
Once pain-free movement and function are restored, your Physiotherapist will work with you to help strengthen the muscles around the knee and build joint stability. This will progress to a graduated resistance and functional retraining program which will aim to ensure that you return to your pre-injury level of function.
A full recovery may take anywhere between 1-4 weeks for low grade sprains, and up to 12 weeks for higher grade sprains, depending on your functional goals.
Risk of Re-Injury and Prevention
The best way to prevent re-injury is to engage in a progressive strengthening program alongside other strategies such as:
- Performing a warm-up and cool-down prior to engaging in physical activity
- Using a supportive knee brace
- Wearing supportive footwear
Overall, Physiotherapy is associated with high rates of success and return to sport post MCL sprain. Engaging in a comprehensive physiotherapy rehabilitation program has been associated with low reports of long-term instability in Grade I and Grade II MCL sprains and a re-injury rate of as little as 3% in elite athletes.
References
Duffy, P. S., & Miyamoto, R. G. (2010). Management of medial collateral ligament injuries in the knee: an update and review. The Physician and sportsmedicine, 38(2), 48–54. https://doi.org/10.3810/psm.2010.06.1782
Phisitkul, P., James, S. L., Wolf, B. R., & Amendola, A. (2006). MCL injuries of the knee: current concepts review. The Iowa orthopaedic journal, 26, 77–90.
Lundblad, M., Hägglund, M., Thomeé, C., Hamrin Senorski, E., Ekstrand, J., Karlsson, J., & Waldén, M. (2019). Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 27(11), 3692–3698. https://doi.org/10.1007/s00167-019-05491-6
Lavoie-Gagne, O. Z., Retzky, J., Diaz, C. C., Mehta, N., Korrapati, A., Forlenza, E. M., Knapik, D. M., & Forsythe, B. (2021). Return-to-Play Times and Player Performance After Medial Collateral Ligament Injury in Elite-Level European Soccer Players. Orthopaedic Journal of Sports Medicine, 9(9), 232596712110339. https://doi.org/10.1177/23259671211033904
Knee Ligament Sprains and Tears: Clinical Practice Guidelines Ensuring Best CareJournal of Orthopaedic & Sports Physical Therapy 2017 47:11, 824-824
Naqvi U, Sherman Al. Medial Collateral Ligament Knee Injury. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431095/