Article by Sydney sports physio, Chris El-Hayek
What is the Role of the MCL?
The MCL is a ligament on the inside of the knee, that connects to the thighbone (femur) at the top, and shin bone (tibia) at the bottom. This ligament helps to stabilise the knee from excessively collapsing inwards.
How Does an MCL Injury Occur?
MCL injuries typically occur when valgus stress (Inwards stress) is placed on the knee. This typically happens when the knee is hit on the outside with a planted foot, causing excessive stretch of the MCL ligament on the inner knee. This most commonly happens in sport, where the athlete’s outer leg is hit or tackled forcefully. Less commonly, the ligament can also get injured when our knee collapses inwards from a sudden change of direction or awkward landing.
Injury Severity & Duration
MCL ligament injuries are usually graded from 1-3, depending on how much of the ligament has been torn. In some cases, there can be a mild tweak/stretch of the ligament that can be labelled as grade 0, and function would return quite rapidly in this situation.
Grade 1 – Minor ligament damage, can still be painful and produce mild swelling and tenderness. Function is still good, there is usually no joint laxity, and return to activity may take 2-4 weeks.
Grade 2 – Moderate ligament damage, with higher levels of pain and swelling. May be associated with joint laxity on assessment from a physiotherapist. Range of Motion (ROM) braces can be used to improve stability and healing of ligament as determined in physio assessment. Typically out of sport for 4-8 weeks.
Grade 3 – High grade ligament tear, or in some cases complete rupture of the MCL ligament. This would always need a ROM brace, and crutches in the early stages. Review from an orthopaedic specialist is needed for a surgical opinion depending on the extent of damage. Generally out of sport for at least 3+ months.
Medical Imaging
If there is suspicion of a grade 2+ MCL injury, an MRI is gold standard in confirming the diagnosis and overall nature, extent, and location of injury. An MRI will also rule out damage to other structures in the knee. If there is any concern for an associated fracture, an Xray can be done quickly (no booking is required) to rule this out while waiting for your MRI.
Above: MRI Imaging showing tear of a patient’s MCL
How a Physiotherapist can Help in the Treatment & Management of an MCL Injury
MCL injuries shouldn’t be taken lightly. It is important to see a physiotherapist early to get a confirmation of diagnosis. You can then start the healing process as quickly as possible. In your appointment, our physios will quickly determine whether or not you need a ROM brace. They will also determine if any medical imaging referrals (Xray and/or MRI) are needed.
Once your diagnosis is confirmed, you will quickly start treatment and rehabilitation. This will consist of pain and swelling management strategies in the early stages. For example: manual therapy, use of our Normatec compression boots, and our Electrical Muscle Stimulation device – Compex. You will be assessed regularly to gauge your level of progress, and exercise rehabilitation will commence as early as safely possible, with ongoing supervision.
During your mid to late-stage rehabilitation, strength & conditioning and injury prevention strategies will be implemented, so you return to full function, and minimise the risk of re injury when you return to sport.
Do you need assistance managing or treating a knee ligament injury?
Our sports physiotherapists have extensive expertise in offering physiotherapy services to a range of patients in varying sports at the highest level. We have been able to assess and treat numerous athletes with a wide range of complex sport-related injuries, with high success in minimising re-injury while enhancing our patients’ athletic qualities.