Knee Ligament Injury
MCL Injury
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The medial collateral ligament or MCL, is a strong ligament on the inside of the knee. Injury to the MCL can occur through sport, trauma or chronic overload. Injury is from a stretch to the ligament which can strain it, at higher forces the ligament may become torn and this can be classified into 3 grades, from minor to complete tear. You can read more about this in our related article: MCL Injury. Treatment and management for all injuries will initially start with a period of rest. For more severe injuries a brace may be needed to immobilise the joint and aid healing. Rehabilitation will follow with differences depending on the severity, mechanism of injury and the goals that the individual wants to return to. Here we will discuss the common treatment of how to heal an MCL injury in these different scenarios.
Diagram of MCL Injury
Grade 1 MCL Tear
Symptoms of low pain, without swelling or joint instability.
Minimal damage with less than 10% of ligament fibres torn.
Assessment will find pain on palpation of the ligament with 0-3mm of excess movement of the joint.
Grade 2 MCL Tear
Symptoms of moderate to high pain, with swelling and very mild if any joint instability.
Moderate damage with more than 10% of ligament fibres torn.
Assessment will find pain on palpation and swelling, and there is 5-10mm of excess movement of the joint with pain.
Grade 3 MCL Tear
Symptoms of high pain, with swelling and joint instability.
Severe damage with complete or near complete rupture of the ligament.
Assessment will find pain on palpation, swelling and >10mm of excess movement of the joint or no end feel to ligament stress tests, this may be accompanied by pain if the tear is not complete, or can be pain-free if completely ruptured.
Treatment of Grade 1 MCL Tears
An initial period of home treatment involves rest and ice, and if there is swelling compression and elevation, for several days to a week. No sport and minimal walking should be performed during this time. Exercises for joint mobility, muscle flexibility and activation of the quadriceps are useful during this period. If pain is high crutches might be helpful for mobilising but are not often needed for this level of injury.
Further rehabilitation should follow this period of rest. A biomechanical assessment is useful once the pain has subsided to see movement quality and address areas that are tight or weak that may have contributed to the injury or impact recovery. In addition, building strength in the muscles of the leg around the knee joint will help support the knee.
Recovery from a grade 1 MCL injury is between 1-4 weeks.
Treatment for Grade 2 & 3 MCL Tears
The initial rest period of 2-4 weeks, should include the use of a brace, and in most cases for grade 2 and with all cases of grade 3 tears, crutches will be used to reduce weight bearing and manage pain. Ice can be used for pain relief along with medication if needed, and as there will be swelling, compression and elevation are strongly recommended.
Rehabilitation should be guided by a medical professional such as a physical therapist. They can recommend what brace you should use. A brace should support medial and lateral movements and hinged braces can be fixed to restrict the range of movement. Straightening the knee fully past 20º of flexion and bending the knee over 90-100º will put the MCL under more strain and can delay healing.
Rehab protocols include early activation exercises for the quadriceps muscles as this can facilitate faster recovery, and other exercises will be prescribed to you depending on your needs. You can read more about exercises in our related article: MCL Injury Exercises.
Recovery from a grade 2 MCL injury is between 4-6 weeks and from a grade 3 MCL injury is between 6-8 weeks but can take longer if surgery is required.
Will I Need Surgery?
In most cases surgery is not necessary or advisable. In circumstances where other structures that are damaged and needing surgical repair, such as the anterior cruciate ligament or meniscus, then the surgeon may consider operating on the MCL at the same time. Surgery will help to stabilise the joint by reattaching the torn part of the MCL together or using a graft to provide the additional support.
Massage
Massage is an effective additional treatment to help relax tight muscles and help regain movement of the knee. In addition, massage can help to reduce tension in areas of the body that might work harder when you are moving differently when wearing a brace or using crutches.
Acupuncture
Acupuncture is a safe and effective treatment for relaxing tight muscles and for pain relief. It can be used for MCL injuries and is effective for relieving short-term pain and dysfunction (Ji-Won Lee et al, 2020).
You can read more about treatment, rehabilitation exercises and prevention exercises in our related article: MCL Injury Exercises.
Physiotherapy with James McCormack
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.