Our knees are among the hardest working joints in our bodies, and they have unbelievable forces to deal with, which means stability is important. The median collateral ligament (MCL) plays a role in keeping the knee stable, so you should have MCL injuries treated as soon as possible.
Sports Med London offers diagnosis as well as top-quality surgical and non-surgical treatments for injured MCLs. Find out more below.
Where Is The MCL?
The MCL begins at the inner side of the thighbone (femur) and passes down the side of the knee to eventually attach to the inner side of the upper shinbone (tibia). The ligament helps keep the knee stable against loads that cause the shinbone and foot to move outwards and the thighbone to move inwards (valgus forces).
How MCL Injuries Happen
Most MCL injuries happen because of an impact to the knee from the outside, such as colliding with another player while playing a contact sport such as rugby or football. You can also injure your MCL by suddenly side stepping or changing direction when your foot is planted firmly on the ground.
Types of injury include stretches, partial tears (sprains), and complete tears (ruptures). MCL injuries are among the most common injuries that happen to knee ligaments. The anterior cruciate ligament (ACL) often tears at the same time as the MCL is injured.
MCL injury symptoms include:
- Pain on the inner side of the knee
- Catching or locking sensation when you move your knees
- Feeling as though your knee will give way suddenly
Our specialist will ask you about your health history and how the injury happened, and they will perform a physical examination. You will also have an MRI scan to find out how big the injury is and to see if there are any other problems, such as a tear in the cartilage known as the meniscus.
Treatment For MCL Injuries
Not all MCL injuries need surgical treatment. Depending on the seriousness of your injury, our specialist may recommend that you use a knee brace and perform physiotherapy exercises. The excellent blood supply to the MCL is one of the reasons it can heal minor injuries when prevented from moving.
You may require surgery if the problem is part of a multi-ligament injury, or if your ACL or meniscus are also injured. During surgery, the specialist might use special sutures to reattach the torn end of the ligament to the bone. If the ligament cannot be repaired, the specialist might use a tissue graft to reconstruct it. You will need to follow a physiotherapy rehabilitation program after reconstructive surgery. You can start playing contact sports again about nine months after surgery. Find out more below.
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.