The medial collateral ligament, or MCL, is a key ligament on the inside (medial) of the knee. It is not unusual to see it injured in athletes involved in sports like soccer and football. This often happens when they are hit on the outside of the knee, collasping the knee inward. The MCL is very different from the ACL in terms of how it tears and how it is treated.
Symptoms of an MCL tear
The athlete will often feel a popping or tearing sensation on the inside of the knee. There is usually sharp pain associated with this. Often, swelling will develop over this inside area of the knee, but not within the joint itself. It may be difficult to bend your knee for a few days, and will likely be painful on the inside of the knee when you try to walk.
Examination of an MCL tear
When I look at someone with an MCL tear, there is usually point tenderness directly over the attachment spot of the MCL on the end of the femur, or thigh bone. This is located at a specific spot called the medial epicondyle which is located just above the joint line. There is often pain along the joint line as well, but the more focal pain is founded just above this. Patients will have pain when I try to stress the knee inward.
In the acute setting, it can sometimes be difficult to differentiate between a MCL tear and a meniscus tear or potentially a fracture or damage to the bone/cartilage near the inside of the knee.
Imaging studies to assess an MCL tear
The best imaging test to look at an MCL tear is an MRI scan. Typically, x-rays will not show the soft tissue injury. It is unusual to see a fracture associated with these ligament injuries. The MRI test will show swelling around the ligament and detachment typically from the femur as described above. While not as common, the ligament may also tear somewhere along its midpoint, or from the tibia bone. This test will also help differentiate a meniscus tear or potential cartilage damage.
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Severity of an MCL tear
Injury to the medial collateral ligament can range from a simple sprain to partial tears to complete tears. This can be diagnosed sometimes with examination alone and most definitely with an MRI.
Treatment of an MCL tear
Isolated MCL tears, fortunately, have the ability to heal on their own and do not require any surgery. This is a unique property of the MCL, unlike other ligament tears such as ACL tears which do not have the ability to heal on their own. It is best to see an orthopedic sports medicine specialist, possibly have an MRI study and be properly evaluated. Again, for the isolated injury, these tears will heal well on their own. A hinged knee brace is often helpful to protect the knee during this process. As the pain decreases, physical therapy is often helpful to help work on range of motion and slowly regained strength. After this, a functional program to increase activity level and then slow return to full activities is essential. Although experimental, platelet rich plasma may be another treatment to consider. Remember that often times MCL tears occur in conjunction with other injuries like meniscus tears and cartilage injuries and might require more treatment.
Take-home message on an MCL tear
While medial collateral ligament tears are significant knee injuries, they typically heal well on their own. A good examination is important to be sure nothing else was damaged as these often go along with other injuries. Surgery is almost never needed for isolated injuries. Most athletes are able to return to full activities in 3 to 4 months, sometimes sooner.
Learn more from the American Academy of Orthopedic Surgeons about MCL Tears.