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What is a Medial Collateral Ligament (MCL) Injury of the Knee?

What is a Medial Collateral Ligament (MCL) Injury of the Knee?

By Laurence APAM


What is the MCL?

The MCL stands for Medial Collateral Ligament. The MCL does not solely exist in the knee as other areas of the body also have an MCL, e.g. the elbow. Medial refers to the inside part of the body, collateral meaning an accessory part and ligament being a strong connective tissue. The MCL attaches from the inside of the femur, running along the knee and attaches on the medial aspect of the tibia. The MCL is one of four knee ligaments that are critical in maintaining support of the knee.


What injury can occur to the MCL?

MCL injury can include a stretch, partial tear or complete tear of the ligament on the inside of the knee. Other injuries that may masquerade as a MCL injury include medial meniscus, ACL tear, patella dislocation, tibial plateau fracture, medial knee contusion (bruise).


How do injuries to the MCL occur?

MCL injuries are one of the most common injuries of the knee. It occurs when a valgus force causing the ligament to stretch beyond its structural capabilities. A valgus force is one that pushes the outside of the knee inwards, causing a stretching of the medial structures. Generally, this occurs from impact, or when the lower leg is in contact in the ground and unable to move. A combined movement of flexion/valgus/external rotation is the main mechanism of injury to the MCL.


What are the Symptoms of an MCL injury?

MCL knee injuries are graded on a 1 to 3 scale, with 3 being a complete rupture of the ligament. Depending on the degree of injury will determine the presentation of the condition.

Grade 1: Mild medial knee pain, mild swelling, possible limp and tenderness on palpation of MCL ligament.

Grade 2: Moderate medial knee pain, moderate swelling, limping and instability.

Grade 3: Severe medial knee pain, heavy swelling and knee gives way under valgus force.


What is the management for injuries to the MCL?

Initially, it is important to determine the extent of the injury. In more severe cases of knee trauma, the MCL along with other structures will also be injured. For example, if a complete rupture of the MCL ligament has occurred (grade 3), it is extremely likely there is damage to a surrounding ligament or knee cartilage. ACL and other knee ligaments should be screened after any suspected MCL injury.

Majority of MCL injuries can be treated non-operatively, requiring physical therapy for a period of weeks. However, for grade 3 ruptures, it is likely to require surgery. In the initial phases of rehabilitation, you will want to:

  • Reduce swelling.
  • Activate quadriceps muscle, particularly VMO.
  • Restore range of motion as early as possible.

A comprehensive rehabilitation program is critical during recovery. This will include the ability to control the knee and regain strength in the surrounding structures. This will take anywhere from 2 – 12 weeks for majority of cases.


Can MCL injuries be prevented?

Yes, to a certain extent. During contact sports it is sometimes impossible to avoid injury when unexpected forces interact with the knee. However, there are ways to significantly reduce the likelihood of the knee being in a dangerous situation, for both contact and non-contact sports.

  • Appropriate neuro-muscular warm up – control/proprioception exercises. This includes single leg landing and explosive change of direction.
  • Strengthening and control programs – building up strength and control in lower limb and trunk to ensure proper alignment and reduce the risk of the knee being in a poor position.



If you have any questions about knees or MCL injuries, please contact us or book online for an appointment.

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