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Medial Collateral Ligament (MCL) Injury
The medial collateral ligament (MCL) is one of four
ligaments that are critical to the stability of the knee
joint. A ligament is made of tough fibrous material and
functions to control excessive motion by limiting joint
mobility. The four major stabilizing ligaments of the knee
are the anterior and posterior cruciate ligaments (ACL and
PCL, respectively), and the medial and lateral collateral
ligaments (MCL and LCL, respectively).
The MCL spans the distance from the end of the femur (thigh
bone) to the top of the tibia (shin bone) and is on the
inside of the knee joint. The MCL resists widening of the
inside of the joint, or prevents "opening-up" of the knee.
Symptoms of Medial Collateral Ligament Tears
If the medial collateral ligament has been damaged or torn,
you will usually have:
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Pain, which can range from mild to severe, depending on
how serious your injury is
-
Stiffness
Swelling
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Tenderness along the inside of the knee
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A feeling that your knee may give way under stress or
may lock or catch.
Causes and Risk Factors of Medial Collateral Ligament
Tears
Injuries to the medial collateral ligament most often happen
when the knee is hit directly on its outer side. This
stretches the ligaments on the inside of the knee too far or
can tear them. It is not uncommon for athletes to suffer
tears of the medial collateral ligament and anterior
cruciate ligament at the same time. The ligament also can be
injured through repeated stress. This causes the ligament to
lose its normal stretch and elasticity similar to a worn-out
rubber band.
Diagnosing Medial Collateral Ligament Tears
Your doctor will generally ask you to describe how the knee
was injured, whether you have had other knee injuries and
how your knee has felt since the injury. You may be asked
about your physical and athletic goals. This helps your
doctor decide what treatment might be best for you.
During the physical exam, the inside of the knee will be
checked for pain or tenderness. Pressure will be put on the
outside of the injured knee while the leg is both bent and
straight. Depending on the degree of pain or looseness of
your knee joint, the injury will be classified as:
Grade 1: Some tenderness and minor pain at the
point of the injury.
Grade 2: Noticeable looseness in the knee when
moved by hand; major pain and tenderness at the inside
of the knee; swelling, in some cases.
Grade 3: Considerable pain and tenderness at the
inside of the knee; some swelling and marked joint
instability. The knee opens up about one centimeter
(slightly less than half an inch) when the doctor moves
your leg around. A grade three MCL tear often occurs
along with a tear of the anterior cruciate ligament.
If the immediate pain and swelling makes it too
difficult to judge how severe the injury is, you may
need to wear a light splint, apply ice and raise the
knee. Once the swelling and pain have lessened, your
doctor will make the diagnosis.
Your doctor may order a magnetic resonance imaging (MRI
) scan. An MRI has an accuracy rate of nearly 90% in
determining whether and how badly a medial collateral
ligament tear is. It is not very good, however, at
detailing a partial tear.
When surgery is done, it is usually done through a small
incision on the inside of your knee. It is not done
arthroscopically, since this ligament is not inside the
knee joint. If the medial collateral ligament has been
torn where it attaches to the thighbone (femur) or
shinbone (tibia), the surgeon will re-attach the
ligament to the bone using large stitches or a metal
screw or bone staple. If the tear was in the middle of
the ligament, the surgeon will sew the torn ends
together.
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