Medial Collateral Ligament Strain

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A medial collateral sprain is a ligament condition located on the inner aspect, or most specifically, a part of your knee. Although, it is basically outside of the joint itself. The ligaments hold bones together meanwhile adding a strong amount of stability and strength onto a joint. The medial collateral ligament (will be mentioned as MCL) then connects the top of the tibia, or shinbone, to the bottom of the femur or even the thighbone. Now as to the injury, if it occurs against the MCL, it is often called a medial collateral sprain. Ligament injuries can either stretch out the targeted ligament or tear it. MCL injury of the knee is normally caused by a direct physical blow to the knee. This type of injury commonly occurs in sports. It can usually result in a harsh hit or blow to the outer aspect of the knee, which then stretches or tears the MCL, developing the early stages of a medial collateral ligament sprain.

The MCL is anatomically composed of a superficial layer and also a deeper layer. The superficial layer runs from just posterior to the medial femoral epicondyle down 6 centimeters beyond the medial tibial plateau. The deep layer is a thickening of the joint capsule itself; as it is composed of the meniscofemoral and meniscotibial components. MCL injuries commonly involve the proximal fibers of the superficial later. This type of injury is extraarticular, therefore, in isolated MCL injuries, medial knee swelling can occur, although intra-articulate effusion will be absent.

MCL injuries are also more common than lateral collateral ligament (LCL) injuries. Isolated LCL injuries are somewhat rare, therefore accounting for 2% of knee ligament injuries. LCL injuries are more commonly accompanied by a profound injury located to the knee, often involving the posterolateral corner structures in adults.

Causes & Symptoms

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A medial collateral ligament sprain occurs as a result of an excessive valgus load and/or a rotation of the external tibial. The femoral attachment experiences great stress with valgus loads. At 30 degrees of knee flexion, the LCL serves as the primary stabilizer against various stress. The MCL injuries typically occur in contact, cutting, and collision in sports (for example skiing and ice skating).

Similar to as mentioned earlier, medial collateral sprains are the most common type of knee injury, so below I will describe three grades of causes that can lead to developing this specific injury:

 

Grade 1 – A grade 1 MCL injury indicates a mild sprain or stretching of the ligament fibers. It may cause mild to moderate pain and slight swelling, however, the knee remains stable.

 

Grade 2 – Grade 2 of the MCL injuries indicate a higher severe sprain or stretching of the ligament. Pain and swelling become more severe and could cause noticeable instability inside the affected knee joint.

 

Grade 3 – A grade 3 MCL injury is finally a total rupture (complete tear) of the ligament. The pain and swelling are now at an extremity so severe, the knee joint is destabilized.

 

Despite the grades of how severe medial collateral sprain may become, these symptoms can also be linked to this certain condition as described below:

 

  • A popping or snapping sound during the initial injury

 

  • Immediate pain and swelling of the injured knee

 

  • A feeling of instability or looseness inside the injured knee

 

  • A feeling of buckling or giving out in the injured knee during movement

 

  • A certain limited range of motion in the injured knee.

Who Gets An MCL Strain?

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The MCL is injured in at least 42% of ligamentous knee injuries, with isolated MCL injuries for 29% of these conditions stand-alone. Inside the population, the incidence of this type of injury is 0.24/1000 people or 74,000 injuries annually. MCL sprain is the most common knee injury in high school athletes. Targeting young athletes, one study discovered that females have a higher rate of MCL injury at the high school level, while males have a higher rate of injury at the college level. However, there was no significant sex disparity when medial collateral sprain injuries were compared between sexes within a given sport. Skiing accounts seen for a much larger percentage of both MCL and LCL injuries, making up to 60% of skiing-related injuries. MCL injuries are commonly seen in contact sports such as American football, soccer, hockey, and rugby. In a more cohort study of athletes dealing with isolated medial collateral ligament sprains, the average amount of time lost per injury was 23.2 days.

How Does It Affect You? How Serious Is It?

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As serious as medial collateral ligament sprains can get, this condition sprains or tears often occur alongside damage to the meniscus or the anterior crucial ligament.

A torn knee ligament can destabilize the affected knee and prevent you from doing productive things that involve twisting or turning your desired knee. Twisting or turning motions on a torn medial collateral ligament may then cause the knee to buckle. These ligament injuries often cause significant pain, stiffness, and instability in the knee joint, and they require immediate medical attention.

On most rare occasions, an injury to the medial collateral ligament will require further surgery. Surgery is highly necessary whenever the specific ligament is torn in such a way that it cannot repair itself. It’s also done when the MCL sprain occurs with other ligament injuries. Before surgery, the surgeon may use arthroscopy to thoroughly examine the extent of the patient’s injury, therefore observe for associated injuries inside the affected knee. Arthroscopy involves inserting a tiny, thin camera through a small incision, or a cut.

After the arthroscopic exam, the surgeon will then make a small incision along the inner aspect of the knee. If the ligament is torn where it is attached to either the shinbone or the thighbone, the surgeon may use one of these to reattach them back together:

 

  • Large stitches

 

  • Bone staples

 

  • A metal screw

 

  • A device called a suture anchor

 

If in case the tear is in the middle of the ligament, the surgeon will be able to stitch the ligament together.

Recommended Treatment & Rehabilitation

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A physical examination will help to ensure a correct diagnosis. A medial meniscal tear can be easily mistaken for a medial collateral ligament sprain because the tear causes joint tenderness such as the sprain. With a valgus laxity examination, a medial meniscal tear can be differentiated from a grade 2 or 3 of the MCL sprain. The presence of an opening on the injured joint line means the medial meniscus tear. The differentiation can be made through an MRI or by observing the patient for several weeks. In the case of a medial collateral ligament sprain tenders normally resolves, with a meniscal injury it persists. When there is tenderness, although no abnormal valgus laxity, it could be a case of a medial knee contusion. If the tenderness is situated near the adductor tubercle or medial retinaculum adjacent to the patella, the cause is more likely to be a patellar dislocation or subluxation. Patellar instability may be differentiated from a medial collateral ligament sprain with the patellar apprehension test. A positive result means there is patellar instability.

If the patient is a child, a gentle stress-testing radiograph can determine if they have a distal femoral fracture instead of a medial collateral ligament sprain. The patient’s anamnesis is much important to understand where the pain is located. After determining where it hurts, the therapist has to feel if there is tenderness or soft-tissue swelling. For this type of situation, the therapist needs to palpate the injured knee joint. In most cases, the pain is localized on the medial side of the knee. Soft-tissue swelling will also be present. As mentioned before, there are three grades of MCL tear. the grade depends on the degree of pain or on the range of the opening of the joint space during stress tests of the patient’s knee point:

 

  • MCL valgus stress test

 

  • Swain test

 

  • Anteromedial drawer test

 

The recommended treatment of a medial collateral ligament sprain depends on the severity of the specified injury. Treatment always begins by allowing the pain to subside, then beginning work on mobility, followed by strengthening the knee to return to either sports or activities. Bracing can often be useful for the treatment of medial collateral ligament injuries. That being said, below I will describe each treatment depending on how severe an MCL injury can worsen:

Treatment of grade 1 MCL sprains

 

Grade 1 sprains of the MCL often resolve within a few weeks. Treatment may consist of:

 

  • Resting from activity – (meaning you will not be playing the sports where you sustained the injury while you recover)
  • Icing the injury
  • Anti-inflammatory Medications
  • Knee exercises

 

Patients with grade 1 MCL sprains may be able to return to their activity within one or two weeks after their injury has recovered fully.

 

Treatment of grade 2 MCL sprains

 

When a grade 2 medial collateral ligament sprain occurs, patients should brace their knee and use helpful equipment such as crutches until the pain has subsided. The knee may be immobilized for a few days initially, although early range-of-motion will help in the process of early recovery. Patients with a grade 2 injury may be able to return to activities within three to four weeks after their injury recovery.

 

Treatment of grade 3 MCL sprains

 

As a grade 3 MCL sprain persists, patients should brace their knees and use crutches until the pain has truly come to an end. The knee can be immobilized for over a few days initially, however early range-of-motion will help in the recovery process.

Once the patient can begin bending their injured knee, range-of-motion exercises should commence sooner, including stationary bicycling. Normal walking and jogging can begin as pain allows. A hinged knee brace is a normally helpful support to the knee, Many athletes return to sports about three months after a grade 3 medial collateral ligament sprains.

Fortunately, most surgical procedures are not necessary for the treatment of a medial collateral ligament sprain. In some specific circumstances, however, surgery may be recommended. Most often, surgery is used for the treatment of some specific types of severe MCL injuries in general.

 

Rehabilitation

 

In most cases throughout every physical condition that comes by to a specific patient such as one living with a medial collateral ligament sprain injury, performing exercises is a number one at-home therapy that can greatly reduce any symptom regarding this type of condition at a drastic amount. Here are some examples of exercise methods for you to try. The exercises may be suggested for a condition or for rehabilitation. Start each exercise slowly, and ease off the exercises if you start to experience pain:

 

Knee flexion with heel slide

 

Lie on your back with your knees bent. Slide your heel back by bending your affected knee as far as you can. Then hook your other foot around your ankle to help pull your heel even further back. Hold this position for about 6 seconds, then lastly rest for up to 10 seconds. Repeat the same procedure 8 to 12 times.

 

Heel slides on a wall

 

Lie on the floor close enough to a wall so that you can place both legs up on the wall. Your hips should be as close to the wall as it is comfortable for you. Start with both feet resting on the wall. Slowly let the foot of your affected leg slide down the wall until you feel stretch from inside your knee. Hold this position for 15 to 30 seconds. Afterward, slowly slide your foot up to where you began. Repeat the entire steps 2 to 4 times.

 

Lateral step-up

 

Stand sideways on the bottom step of a staircase with your injured leg on the step and your other foot on the floor. Hold onto the selected banister or wall. You then use your injured leg to raise yourself up, bringing your opposite foot level with the stair step. Make sure to keep your hips level as you perform this exercise. Try to keep your knee moving in a straight line with your middle toe. Do not put the foot you are raising on the stair step. Finally, slowly lower your foot back down. Repeat the same exercise 8 to 12 times.

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