Medial collateral ligament (MCL) injury

This picture shows the right knee, viewed from the front. The medial collateral ligament is shown in red on the right hand side of the image.

The MCL is a ligament located on the medial (inner) side of the knee that connects the femur (thigh bone) to the tibia (shin bone) and prevents widening of the inside of the knee joint. It is one of the 4 key ligaments of the knee. Injury to the MCL usually occurs when the knee is bent a little and as a result of a valgus stress, meaning a force exerted directly onto the outside of the knee, that causes the inside of the joint to ‘open’. MCL injuries are common in downhill skiing and contact sports and are classified according to their severity. This classification helps clinicians decide on the best course of treatment and predict how you will recover and return to normal function.

The classifications are:

  • Grade 1 (mild): This is mild sprain to the MCL ligament. Pain can be experienced on fully bending, straightening, twisting and when the outside of the knee is pushed, stressing the inside of the knee. However, this grade of injury does not cause any ‘looseness’ as most of the MCL is not torn. Most athletes are able to return to sport within 3 weeks although it can take longer for the pain to settle.
  • Grade 2 (moderate): This is an incomplete tear, involving about half of the MCL. People with a grade 2 injury typically report instability of the knee, for example the knee may feel ‘loose’ or ‘wobbly’ when pivoting or simply changing direction when walking. On examination there is localised swelling and addition to tenderness over the inside of the knee where the ligament is situated. Rehabilitation from these injuries is necessary. Most people can return to sport after approximately 4-6 weeks although it can take longer for the pain to settle.
  • Grade 3 (severe): These injuries mean that the ligament is completely torn, If you have a grade 3 tear, you often experience significant instability and the knee might feel ‘wobbly’ in certain positions. Despite the increased severity of the injury the amount of pain experienced can and can be less painful than a grade 1 or 2 injury. Examination of the knee shows laxity when a valgus stress is applied, meaning that the inside of the knee ‘opens’ up a lot when the clinician pushes on the outer side of the knee. Also significant swelling can be seen over the area. Sometimes, grade 3 tears occur in association with an anterior cruciate ligament (ACL) injury.

Grade1 and 2 tears (classified of sprains) have excellent outcomes when treated with physiotherapy. Treatment of Grade 3 tears can be treated either conservatively or with surgery and the scientific literature suggests no difference in length of time to return to sport between the two methods. Considering the risks associated with any surgical procedure, conservative management should therefore be attempted first. Please refer to the section on physiotherapy for an example of an exercise programme.

Medial Collateral Ligament Reconstruction

The video below shows a detailed explanation of the causes and presentation of Medial Collateral Ligament Reconstruction. They show a basic outline of the procedures used by Amir Qureshi and after care required in order that you, the patient, may recover to your full fitness once again.