Medial Collateral Ligament Tear
What is it?
The medial collateral ligament (MCL) ligament is located on the medial (inside) side of the knee. It prevents the knee from gapping when one tries to twist to the inside. An MCL injury can be a stretch, partial tear, or complete tear of the ligament.
How does it get hurt/damaged?
An MCL tear occurs when a patient is twisting to the outside and the knee gives out or when you get hit on the knee, such as a clipping injury while playing football, soccer, or basketball.
MCL tears happen in a couple ways. If the knee gaps to the outside when the knee is out straight, called vagus gapping in extension; or when the MCL tears at its attachment on the shinbone (tibia), it retracts towards the knee, causing a tear that is referred to as a Meniscotibial MCL Tear, which usually will not hear on its own.
How common is a meniscus tear?
MCL tears happen quite often, especially in men. Men are twice as likely to tear their MCL as women, especially in active individuals. Throughout the US, there are about 750,000 MCL tears per year.
When should you be worried about an MCL tear and what should you do initially?
MCL tears can initially be less concerning if left in isolation. If you experience an injury and find that you have pain on the inside (medial) side of your knee, along with instability, you should set an appointment with your doctor as soon as possible.
If you have an injury and experience numbness, tingling, gross instability, or an inability to walk, get to your local emergency room and see a physician there.
What is the severity of the injury and the treatment options?
The severity of MCL tears is graded on a scale of 1-3. MCL tears that do not completely gap open but do endure some pain localized to the MCL region are considered Grade 1. These tears are classified by full stability with valgus stress at both 0 and 30 degrees of knee flexion.
Grade 2 tears are classified by a partial tear, with moderate to severe pain localized to the MCL region. These tears will also cause valgus stress at the 0 degree of knee flexion but will cause instability at the 30 degree point of flexion.
Grade 3 tears are classified by a complete tear of the MCL and can be identified by complete instability at the 0 and 30 degree points of flexion but will generally cause less localized pain to the MCL region.
Treatment for an MCL tear are generally one of two options. Conservative therapy is usually the course of action for the majority of isolated tears, and tears that are mis-substance of off the femur. Treatment can include rest, non-weight bearing the injured leg, ice, physical therapy, and time spent on a stationary bike to help condition the knee back to working capacity.
The other treatment for MCL tears is surgical repair. Surgery is similar in principle to other ligament injuries. MCL injuries vary slightly however in that instead of using two tunnels, a store anchor can be used to tack the ligament down to the tibia. Instead of putting the ligament in the tunnel and securing it, the surgeon will nail it down to the bone with an anchor. MCL tears are also more commonly repaired with a graft to support the repair, as opposed to ACL and PCL tears, which are almost always reconstructed.
What is my recovery timeline and the anticipated outcome?
Some MCL tears can do quite well healing without surgery, due to the inherent bony stability of the inside of the knee and the heavier blood flow to that area of the knee. Patients can often be back to participation in sports after six weeks post-injury but those who undergo surgery have a much longer timeline for recovery. For those who undergo surgery, six weeks of non-weight bearing activity followed by a gradual increase in activity will likely see a full return to activity within 9-12 months after injury.
