What is the MCL?
The Medial Collateral Ligament (MCL) originates at the medial (inner) side of the femur (thighbone) and attaches to the medial side of the upper tibia (shinbone) for several centimetres. It stabilises the knee against valgus forces (loads forcing the tibia and foot outwards with the femur facing inwards).
What causes an MCL Injury?
The MCL is commonly injured as a result of impact to the outside of the knee. It can also occur with sudden change in direction or side stepping with the foot planted. MCL injuries are the commonest knee ligament injury and include stretches, sprains (partial tears) and complete ruptures (tears). Quite often the ACL may be torn with an MCL injury.
Patients may present with medial sided (pain on the inner side of the knee) knee pain, locking or catching sensation in the knee during movement. Swelling may occur with the involvement of deeper structures and patients may also feel as though their knee may ‘give way’ suddenly or collapse.
How is an MCL injury diagnosed?
Diagnosis is made through the patients history, mechanism of injury and physical examination. An MRI scan will confirm the extent of the injury and other concomitant pathology such as meniscus tears.
How is an MCL injury treated? Surgical vs non-surgical treatment
Most MCL injuries can be managed non-surgically with a combination of physiotherapy and using a knee brace. The MCL has a very good blood supply and has the ability to heal with immobilisation in a brace. Surgery may be indicated if the MCL is part of a multiligament injury or in the presence of meniscus tears and ACL injury.
An MCL may be repaired depending on location and if the injury is acute by reattaching the torn end of the ligament back onto the bone with special sutures. If the tear is irreparable, mid-substance or no longer in the acute phase this may require a reconstruction using a graft which is attached to the end of the femur and upper end of the tibia with special sutures or through bone tunnels held with special mechanical fixation devices.
Following MCL reconstruction, a rehabilitation program with physiotherapy is started to help you to ultimately return to sport and a wider range of activities. Many patients are able to begin a phased return to contact sports by 9 months post-surgery. This is dictated by patients meeting milestones and under the supervision of the surgeon and specially trained physiotherapist.