MCL Sprain – Medial Collateral Ligament Injuries
A MCL Sprain or medial collateral ligament sprain is a tear of one of the four major ligaments that stabilise the knee joint.
Where is your MCL located? What is the function of the MCL in day to day and in sport? What are the causes and types of MCL tears? And what are some things that you and a health professional can do to rehabilitate your MCL and get you back to the activities you love doing? In this article we discuss all things MCL and how to keep a well-functioning knee after an MCL Injury.
Check this out! Our Physiotherapist Ryan Dorahy demonstrates how to strap an MCL injury:
MCL Anatomy:
There are two parts of the MCL, superficial and deep layers. These two components have different bony attachments:
The superficial MCL originates at the medial epicondyle (the inside bump of your femur). One of the attachments blends into the semimembranosus (part of the hamstring) tendon, while the other connects with the posteromedial tibia (the back and inside of your tibia).
The Deep MCL has another two layers to it; The meniscofemoral and the meniscotibial components. The meniscofemoral component originates in the medial epicondyle just below where the above superficial layer connects to and inserts into your medial meniscus. The meniscotibial component originates at the medial meniscus and inserts into your medial tibial plateau.
What does the MCL do?
The MCL provides the knee joint with a range of functions. Firstly it helps passively guide the knee through its normal range of motion in everyday activities. It prevents the shin bone (tibia) from moving forward and prevents hyperextension of the knee joint. However, the major function of the MCL is to resist valgus forces (resist your knee from being moved inward).
What causes an MCL Sprain:
MCL Sprains can occur from one of the following mechanisms (or a combination):
- Impact injury: Impact to the outside of the knee, lower thigh or upper leg.
- Sharp change in direction
- Twisting knee when the foot is fixed
- Landing on a pronated foot from a jump
If you are concerned that you have suffered an MCL Sprain seeking professional help to have the knee properly assessed is recommended.
Grades of MCL Sprain:
As we do with all muscle and ligament injuries; MCL sprains are categorised into grade 1, 2 and 3:
- Grade 1: 10% of the fibres have been torn. Tenderness but no instability.
- Grade 2: Vary in sizes. Generally a significant grade two tear consists of more than 50% of the fibres being torn. Moderate laxity and instability through the knee.
- Grade three: Complete rupture of the ligament. Large laxity on both straight leg and 30 degree valgus stress testing of the ligament
(Reider, 1996)
Signs of an MCL Sprain:
- Grade one tear MCL:
- Inner knee pain (low grade)
- Mild swelling and tenderness when palpating inside of the knee joint
- Stress test: Pain but no laxity (administered by a health professional such as a physiotherapist or osteopath)
- Grade two tear MCL:
- High grade medial knee pain
- Moderate swelling, tenderness on palpation and obvious limping when walking
- Feelings of instability in the knee and even occasional painful episodes of knee buckling inwards when walking
- Grade three tear MCL:
- High grade medial knee pain
- Moderate to high grade swelling present, and walking with an obvious limp
- Feelings of instability and frequent episodes of knee giving way inwardly
What can you do right now for an MCL Sprain?
An MCL sprain is a critical injury as it plays a major role in stabilising the knee joint. As such it requires special attention from a professional. A health professional such as a physiotherapist or osteopath can help assist you in effective healing of the ligament especially with higher grade sprains (II and III).
Icing the affected area: We suggest 20minutes on 30minutes off three times a day of an evening for a period of 48-72hours after the initial injury. Icing will help reduce your pain levels and also it slows down the rate of swelling helping to promote healing. After this period try placing a heat pack on the region to promote new blood flow and nutrients to the region.
A course of anti-inflammatories may help to reduce some of the pain and inflammation associated a with the sprain. Consult with your general practitioner before taking to ensure this is the right course of action for yourself.
MCL taping as demonstrated in the video below is beneficial for unloading the MCL, reducing irritation when moving the knee and creating more stability around the knee joint. It is a good front line treatment. However, grade two and three sprains will require knee range of motion bracing by a health professional.
MCL Sprain Rehabilitation with a Physiotherapist or Osteopath:
Your Physiotherapist or osteopath will determine the extent of your MCL injury. This can be done clinically in the practice. If the health professional suspects that there may be some additional damage such as ACL rupture or meniscal damage, you may be sent for further imaging like a MRI. Time frames for rehabilitation vary depending on the severity of the sprain and if there were any other knee structures damaged. The rehabilitation usually follows this format:
- Reduce pain and inflammation
- Splint with a knee range of motion brace for grade two and three sprains: For a period of three to seven weeks depending on the extent of the sprain and healing time of the individual.
- Normalise knee joint range of motion and gait (the way you walk): Your knee will tend to stiffen up from the inflammation and a period of not using it
- Strengthen knee, hip and ankle
- Improve your proprioception: Your body’s sensory system will become worse after a MCL sprain. Proprioception allows you to determine where your knee is without looking at it. It can also tell you length and tension around the knee without looking at it. This will require rehabilitation along with usual strength training.
MCL Sprain Return to Sport:
An MCL sprain can take anywhere from 4-12 weeks depending on:
- The severity of the sprain:
- Grade 1: 3-6 weeks
- Grade two: 6-10 weeks
- Grade three: 12 weeks +
- The patients personal healing time
- What the person is trying to get back to i.e. walking would be faster than football
- Any other issues coexisting:
MCL Sprain Surgery:
For grades 1 and two MCL sprains, the majority of the isolated MCL injuries can be very well treated by non-operative treatment, regardless of severity. Grade three injuries are typically where you will have surgical intervention. This is generally due to the propensity to have other structures damaged in combination with the MCL. The most commonly damaged structure along with a grade three MCL sprain is the ACL ligament. Isolated MCL grade three sprains are extremely rare.
By Sydney CBD Physiotherapist Ryan Dorahy