MCL Tear

MCL Tear






MCL is the short form of Medial Collateral Ligament which is very much needed for maintaining stability of knee joint. This ligament along with three other ligaments (namely Anterior Cruciate Ligament ACL, Posterior Cruciate Ligament PCL, and Lateral Collateral Ligament LCL) is responsible for effective joint function. A ligament can be defined as group of fiber like substance which controls the excess of motion of joints, thus preventing wear and tear.

MCL ligament is broad and thick band of fibers present throughout the knee joint ranging from end of thigh bone (femur) till top of shin bone (tibia) and is present inside the joint. They are responsible for preventing the widening of joint movement thus preventing opening up of knee joint. Its function is to restrict the movement of the person to over-extend his legs inward and maintaining the stability of the knee joint.

Whenever the knee joint is attacked due to injury or fall, it is the MCL which suffers maximum damage and tear. When external force is applied it moves the knee ligament inside to open widely and in this process, the MCL gets stretched too far thus subjected to injury and tear. Depending on the intensity of injury it can affect other ligaments like ACL and PCL.

Symptoms :

There would be considerable pain on the knee and in most of the cases, the knee joint looks swollen. The inflammation is due to the tearing of MCL and the knee joint may have bruises outside. There can be stiffness of joint, sharp pain inside the knee. For severe MCL injury, the knee may get unstable as if it is ready to “give out” opening the inside part.

The intensity of pain and other symptoms vary with the extent of injury. Children may feel unstable while walking or hear some “pop” sound inside the ligament indicating tearing of ligament.

Diagnoses :

Your doctor will examine the portion of affected knee and may order for X-ray or other imaging tests like MRI to detect the intensity of damage. He may also do Valgus test, in which the affected person will lie down on the table and the doctor gently moves his leg outward twisting his knee over 30 degrees. In case if the knee is very flexible, it is indicative of MCL injury inside.

Types :

There are 3 different types of MCL tear varying in degrees of damage due to injury.

In grade I tear, there can be slight tear or stretching of ligament. The ligament may be still intact with the bone leaving only a portion of it to sag outside. In mild forms of tear, the person can recover shortly and 1-2 weeks of rest is needed. No other treatment is needed, except pain killer medicines.

In grade II tear, the injury can be somewhat severe. There can be intense pain and swelling and it may take around 3-4 weeks for recovery. Treatment is given depending on the extent of damage.

In grade III tear, the MCL ligament falls out and breaks. The person may not be able to bend his knee or bear weight on it. He may not walk properly and will have a feeling of “give out” knee. It may take more than 6 weeks to recover and the person should wear knee bear or splint and should undergo therapy for long.

Treatment :

The therapy and treatment method depends on the grade of MCL tear. Pain killers like Ibuprofen and aspirin are given for controlling pain and the knee is strengthened using knee braces or splints. Very often braces are enough for treating MCL tear. Surgery may not be required for MCL tear. Complete rest is recommended.

Before visiting the doctor, apply ice on the affected knee to reduce inflammation and pain. Wearing a brace will restrict the knee movement on sides thus facilitating healing.

One has to keep the knee in elevated position to reduce inflammation and for reducing blood flow. Sometimes, the child will have to walk on crutches till the ligament is totally cured. It is not good to exert too much pressure on the affected knee since it may cause intense tear inside.

Rehabilitation is recommended on some cases if the injury is severe. It helps in restricting the movement of knee and in reducing the pain due to swelling. Often, the children who come with MCL injury will have to visit rehab center for 3 times a week following exercise regimen at home during rest of the days.

For severe type of injury and tear, the child will have to be on rehab program for extended time along with therapy and medicines.

MCL Tear

MCL Tear

What is MCL Tear?

An MCL tear or Medial collateral ligament tear is a physical injury sustained on the knee, dealing critical damage to one of the vital components of the joint in the knee that offers support and stability to the entire limb and body.

The MCL is one of the four main ligaments of the knee, along with the anterior cruciate ligament, the posterior cruciate ligament, and the lateral collateral ligament – each one an important factor to keeping the knee steady and secure as they are all made of a tough material designed to withstand stress and great power. However, despite their natural durability, these ligaments are not immune to injury and possible permanent damage.

Any form of injury to the MCL can be extremely painful and is mostly brought about by sports accidents. The tear is caused by applying a high amount of stress or pressure onto the joint, which may be achieved through landing onto a bent knee with great force. This incident stretches the MCL beyond it capacity and in consequence, tears the ligament apart. The tear impairs the affected leg’s ability to control flexion, maintain stability, as well as rotate, as each one is a role the medial collateral ligament performs – along with the main function of preventing the leg from flexing inwardly for far too much.

Recovery and treatment for MCL tears depends upon the extent of the injury. The MCL tears are classified according to grades that indicate the degree of damage that has been dealt. The grade of injury is determined according to the symptoms experienced.

Symptoms

The symptoms that accompany the MCL tear are crucial to determining the magnitude of the injury along with the appropriate care needed and the potential for recovery. In general, the following are the typical symptoms of an MCL tear:

• Severe pain, situated directly on the location of the medial collateral ligament


• Development of a Swollen Knee, centered over and around the torn medial collateral ligament


• Appearance of visible bruising on injured area; will usually develop within 2 days after the injury is sustained


• Patient may state that the knee feels unstable or gives the impression of being on the edge of giving out

To further characterize each grade of an MCL tear, each symptom possesses specific features that distinguish the injury to a particular grade alone, possibly classifying the damage as 1st, 2nd, or 3rd grade. The following is the system utilized for determining the grade given to an MCL tear:
Grade I MCL Tear

• Minor pain and tenderness


• Ligament does not feel unstable


• Pain only experienced upon applying pressure onto the MCL

Grade II MCL Tear

• Observable looseness of the knee when moved with assistance


• Instability experienced especially when patient attempts to turn or pivot


• Greater pain and tenderness


• Affected knee is swollen

Grade III MCL Tear

• Extreme pain and swelling


• Limited ability to bend the knee


• Knee is found to give out or buckle as stability is severely impaired

Treatment and Surgery

The treatment necessary for an MCL tear will depend on the grade of the injury. Certain methods are maintained constant regardless of the grade however; these include the control of pain as well as the rehabilitation to regain movement and strength. Braces are also often utilized to supplement treatment by stabilizing and immobilizing the knee while it is still in the process of recovery.

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The specific treatment for Grade I tears is not extensive as the injury is minor and does not leave permanent debilitation of mobility. Treatment consists of maintaining rest and avoiding activity for a period of weeks to give the ligament some time to heal. Pain and swelling is helped through applying ice over the site of the tear, as ice or the application of any amount of cold promotes the constriction of blood vessels supplying the injured area – thereby limiting bleeding and pain. Anti-inflammatory medications are also prescribed to address swelling. The doctor will then prescribe some knee exercises to bring back normal tolerance to movement in the affected knee.

For grade II MCL tears, a hinged knee brace is commonly used for treatment, allowing movement but simultaneously providing support at the same time. Treatments for Grade II injuries are grossly similar to that for Grade I MCL tears.

Grade III MCL tears will require more extensive treatment due to the greater severity of the injury. Patients are given braces for the knee and are temporarily required to make use of crutches for movement while the pain in the injury still persists. After the period of immobilization, the patient will return for regular exercises to engage his or her range-of-motion, improving the joint’s return to tolerating movement.

Another method of rehabilitation apart from range-of-motion exercises involves stationary bicycling. The patient can then progress along treatment by attempting walking and jogging, depending on the severity of the pain that accompanies the activities.

Surgery is only a final resort for severe MCL Tears. The procedure is termed as arthroscopic surgery, involving the repair of the torn ligament or even replacement of the MCL if mere suturing or repair does not appear to suffice.

Recovery

Recovery, like treatment for MCL tears, will depend on the extent of the injury as the time it takes for an injury to heal is directly proportional to the immensity of the damage incurred. For MCL tears that are classified to belong to the lowest grade, Grade I, full recovery may take only about 2 to 10 weeks. Recovery periods for Grades II and III of MCL tears are not as easy to calculate because damage sustained is considerably greater in these cases. In most cases, Grade II MCL tears may require at least a month for full recovery to take place, after which normal sports activities may then be resumed. Grade III MCL tears will need a greater amount of time to heal, taking as much as about 6 weeks up to 3 months before the patient may be able to go back to his or her usual routine of sports and other physical activity.