What is an MCL Tear?
The MCL is called the medial collateral ligament. It is the most commonly torn ligament of the knee. Located on the inside of the knee, and its main purpose is to prevent too much gliding or to bend the knee inward. The purpose of the ligament is to help stabilize the knee.
As with all ligaments, the MCL is made up of a tough fibrous tissue that attaches bone to bone. The MCL attaches to both the femur (thighbone) and the tibia (shin bone) bones. Some understanding of the basic anatomy of the knee helps to understand how an MCL injury occurs.
Each knee is made up of 3 bones, four ligaments, and two cartilage pads. The three bones of the knee are the thighbone (femur), the shinbone (tibia), and the kneecap (patella). The knee is a hinge joint because the main function is to bend and straighten, like a hinge.
For the knee to move, there are muscles and ligaments that surround the knee. The main muscle groups controlling the knee include the thigh muscle (quadriceps) and the muscle grouping in the back of the leg (hamstrings). There are calve muscles in the lower leg that assist with knee movement too.
Ligaments are meant to help stabilize a joint. In other words, the main job of a ligament is to make sure throughout the movement and at rest the bones stay in position. The four main ligaments of the knee are:
- Anterior (front of the knee) Cruciate Ligament-prevents the shinbone from moving too far forward and limits excessive rotation of the knee
- Medial Collateral (inside of the knee) Ligament-prevent over extension of the knee
- Lateral Collateral (outside of the knee) Ligament-keeps the knee stable through full range of motion
- Posterior (behind the knee) Cruciate Ligament-holds together the thigh bone and shin-bone
Each knee has two cartilage pads to protect the joint. The main job of the cartilage is to provide protection and cushioning to the joint structure. Trauma, wear, and tear, or disease processes like arthritis can damage the pad.
Anyone of the structures can be injured, but the MCL is the most susceptible. More often than not, the injury of the MCL occurs is due to direct contact or impact of the outer side of the knee. When this impact occurs, the MCL is forced to stretch as the outer pressure forces sideward movement of the knee. It is not uncommon to have more than one knee structure damaged with this type of injury.
There are three injury grades of an MCL tear:
- Grade I: A mild sprain where the ligament is still intact but overstretched, or a minor tear may be present. Conservative treatment, like physical therapy, is recommended at this phase. Most often you can return to normal activities with a few weeks to a month.
- Grade II: The ligament is still intact with the bones; however, the damage is more severe. There will be more moderate pain and swell on the inside of the knee. The knee will also feel less stable like it is going to give out. This grade of injury requires a longer recovery time. The recommendation is physical therapy. It takes on average 4-6 weeks of recovery.
- Grade III: There is a full tear, or rupture, of the ligament, which means the ligament has pulled away from the bone. This grade causes the most damage to the MCL and often coupled with damage to other knee tissue. The pain is sharp and intense and almost immediate swelling is noted. The knee is unstable and will likely “give way” with weight bearing. Surgery is common at with this level of damage.
What causes knee pain?
The most common cause for an MCL tear is direct contact or impact to the outer knee, which often occurs with athletes especially in football, hockey, or skiing. There are other traumatic causes of an MCL tear too such as falling or a car accident. It is less common but does happen, the MCL over time is overused and breaks down from wear and tear.
Symptoms of an MCL Tear
The most obvious symptoms of an MCL tear include immediate swelling and pain to the inside of the knee. The knee may also feel like it is going to “give out.” Within the same area, there may also be some bruising, stiffness, and tender touch.
Not always, but some will report they hear a “popping” noise, which is more common with a grade III sprain of the MCL. You may have difficulty applying weight on the affected leg. Beyond stiffness, you may have great difficulty bending or moving the knee.
How is knee diagnosed?
If you suspect an injury to your MCL, it is recommended you visit with your local physician or physical therapist. Through a thorough physical exam of the knee, along with a few special knee tests, the MCL injury can be the diagnosis. Despite this, it is still common to have an image done of the knee a more often than not, there may be other tissue or structural damage to the knee.
To thoroughly assess the structure of the knee, your physician may likely order an MRI (magnetic resonance imaging). Grade I MCL tears typically receive conservative treatment. Grade II may need surgery depending upon if there is any other structural damage to the area. Grade III almost always require surgical intervention.
Treatment of MCL Tear
For an MCL Grade, I tear, the recommendation is conservative care. After the immediate injury, within the first 24-48 hours, RICE is recommended.
Rest the affected knee for several days. Don’t do any activity that aggravates the knee. Ice the knee daily. Apply ice with gentle compression for 15 mins, 2-3 times daily for several days. Elevating the leg will also help with circulation and managing any inflammation that may settle within the knee. Also, for the first 1-3 days, it is recommended you support your knee with a brace to avoid any extra movement, especially extension.
For both Grade I and Grade II level injuries, a qualified physical therapist is recommended. Your PT will complete a full exam and establish a plan for full recovery. The main goals during PT will include:
- Reduce swelling and inflammation
- Manage pain symptoms
- Improve range of motion
- Improve strength
- Retrain the soft tissue (muscles, tendons, and ligaments) around the knee to stabilize the knee
- Gradually reintroduce functional activities such as weight bearing, walking, and eventually returning to sports.
In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
In the rare case when surgery is needed, your physician will guide you through pre-and post-surgery recovery expectations, which is typically a minimally invasive surgery, meaning it can be arthroscopically done (small incision). The goal of surgery is to re-attach the MCL to the bone and fix any other structural damage caused by the injury.
Everyone heals a differently, and recovery will vary depending on how much repair was needed. Either way, physical therapy is recommended post-surgery. Post-operatively your PT will help you manage swelling, teach you how to walk with crutches safely, and help reduce any pain.
After a few weeks, your PT will begin gentle range of motion and strengthening exercises. Over time he or she will advance these activities to include balance to retrain your knee to stabilize the joint. After a few months, your PT will help you safely return to functional activities including sports.
As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
If you suspect a Grade I or Grade II MCL tear, it is highly recommended you seek out treatment from your local PT. He or she can help you with conservative treatment for the long-term success of healing and recovery.
To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating knee pain.
If you suspect you have a Grade III MCL tear, it is highly recommended you set up an appointment with your physician. He or she will properly diagnose your knee as well as determine if any other knee structures or tissue are damaged. Based on the findings, your physician will establish the best treatment and recovery plan with you.