Medial Collateral Knee Ligament Sprain

Description

Medial collateral knee ligament sprain is a sprain (tear) of one of the four major ligaments of the knee. The medial collateral ligament (MCL) helps maintain the normal relationship of the femur (thigh bone) and the tibia (a bone in the lower leg) along the inner side of the knee. The MCL prevents the knee from buckling inward and is the ligament most commonly injured in sports. When torn, this ligament usually heals, although it may heal in a lengthened position (slightly loose). Sprains are classified into three grades. In a first-degree sprain, the ligament is not lengthened but is painful. With a second-degree sprain, the ligament is stretched but still functions. With a third-degree sprain, the ligament is torn and does not function.

Common signs and symptoms

• Pain and tenderness on the inner side of the knee

• A popping, tearing, or pulling sensation at the time of injury

• Swelling and bruising (after 24 hours) at the site of the injury

• With lesser degrees of injury, may continue to play

• Knee stiffness

• Limping, often walking with the bent knee

Causes

MCL sprains are caused by a force that exceeds the strength of the ligament. Most commonly this injury is the result of a direct blow to the outer side of the knee, usually while the foot is on the ground, although it may also be the result of a noncontact injury.

Factors that increase risk

• Contact sports (football, rugby) and sports that require pivoting and sudden changes of direction, such as soccer and baseball

• Poor physical conditioning (strength, flexibility)

• Improper equipment

Preventive measures

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes thigh, leg, and knee flexibility, muscle strength and endurance, and cardiovascular fitness training.

• Wear proper protective equipment, such as the correct length of cleats for the playing surface.

• Functional braces may be effective in preventing injury, especially reinjury.

Expected outcome

The MCL usually heals on its own with appropriate treatment. Rarely, severe MCL injuries may require surgery.

Possible complications

• Frequent recurrence of symptoms, such as instability, swelling, and the knee giving way

• Injury to meniscal cartilage, resulting in locking and swelling of the knee

• Injury to articular cartilage, possibly resulting in knee arthritis

• Injury to other ligaments of the knee

• Knee stiffness and loss of knee motion

General treatment considerations

Initial treatment consists of medications and ice to relieve pain and reduce swelling in the knee. Walking with crutches until you can walk without a limp is often recommended (you may put your full weight on the injured leg). Your physician may recommend a knee brace with a hinge to help you regain knee motion while protecting the MCL. Range of motion, stretching, and strengthening exercises may be carried out at home, although referral to a physical therapist or athletic trainer is usually recommended. Rehabilitation of MCL sprains generally concentrates on reducing knee swelling, regaining range of motion, regaining muscle control and strength, and a short period of bracing. For severe MCL sprains or those associated with other knee ligament injuries, surgery may be recommended.

Medication

• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Stronger pain relievers may be prescribed as necessary. Use these only as directed, and take only as much as you need.

Heat and cold

• Cold is used to relieve pain and reduce inflammation. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

When to call your doctor

• Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

Figure 1

Range of Motion and Stretching Exercises

Medial Collateral Knee Ligament Sprain: Phase I

These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Please remember:

• These exercises are meant to gradually allow you to regain motion without increasing any swelling.

• A gentle stretching sensation should be felt.

Range of motion knee flexion

1. Lie on your back with your legs out straight.

2. Slowly slide your heel toward your buttocks. Bend your knee as far as you can comfortably to get a stretching sensation.

3. Hold for ____ seconds.

4. Return your leg to the starting position.

5. Repeat this exercise ____ times, ____ times per day.

Range of motion knee flexion/extension

1. Sit on the edge of a table or chair.

2. Use the uninjured leg to straighten (extend) and bend (flex) the injured leg.

3. Flexion: Cross your ankles, placing the uninjured leg on top of the injured leg. Pull your heels backward under the surface you are sitting on to increase the bend in your knee.

4. Extension: Cross your ankles, placing the uninjured leg under the injured leg. Straighten your uninjured leg to increase how much you can straighten your injured knee.

5. Repeat this exercise ____ times, ____ times per day.

Range of motion gravity knee flexion

1. Lie on the floor as shown with your toes lightly touching the wall.

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