MCL Injury: A Common Cause Of Medial Knee Pain

MCL Injury Is A Common Traumatic Cause Of Medial Knee Pain

Medial ligament injuries of the knee are a fairly common cause of medial knee pain. A medial collateral ligament (MCL) injury is something we see a lot at Sydney Physio Clinic. We regularly treat soccer players, sadly for this cohort spraining your medial ligament is reasonably commonplace. Noting, it is however not exclusively a soccer injury. Other footballing codes and skiing are other sporting endeavors with a relatively high frequency of MCL injury.

Assessing Medial Collateral Ligament Injuries

In a physio practice a medial ligament injury is graded by stress testing the ligament. Assessing for pain and instability. Injury to the medial ligament is classically graded from grades 1-3. Where Grade 1 injury is the most mild type of sprain. Indicating there may be microscopic tearing of superficial and deep ligament fibers.

• Grade 1: MCL sprain has no resulting instability, or laxity on stress testing. Grade 1 MCL sprains tend to have a much quicker recovery time than Grade 2 – 3 MCL injuries.
• Grade 3: Is a complete tear of the MCL. On stress testing any Grade 3 injury, the treating physio will likely note instability and the a lack of a solid endpoint to the test. Complete Grade 3 tears do not typically require surgery. Generally MCL tears of all grades causing acute medial knee pain will not result in any long term functional problems once healed.
• Grade 2: Fills the space between the minor and stable Grade 1 tear, and the unstable complete rupture that is a Grade 3 medial sprain.

An MRI Can Assist Medial Knee Pain Diagnosis

Following acute trauma to the knee, assessment can prove difficult. An acute MCL injury is often painful and there may be swelling, as well as a loss of motion. These things make grading injury severity and treatment planning challenging. In these situations an MRI may be considered. An MRI can be useful where assessment was impaired for one reason or another. Also if damage to other structures of the knee is suspected. This ma include but is not limited to; fracture, meniscal tear, or ACL rupture.

Both ACL and meniscal injuries commonly occur in unison with MCL injury.  Henceforth alternative, or concurrent injuries need to be considered when assessing any suspected MCL injury. Having an MRI can help with the classification of MCL injury. Remembering that no investigation can assess for pain. So findings on MRI don not always correlate with symptoms, and how functional the patient feels.

The Mechanics Behind An MCL Injury

MCL sprains are caused in a couple of ways. One way is from direct contact to the outside of the knee, specifically while the impacted sides foot is planted on the ground. This type of injury is particularly common across the football codes. An side on rugby tackle being a perfect example of how this trauma could occur.

Another contact method for MCL injury causing medial knee pain is related to a tackle technique common in soccer. Where two players challenge for the ball with the inside part of their foot. The meet the ball at the same time however, the force of one player overwhelms the other. Causing the others lower leg to stretch out to the side. Stretching the medial ligament causing injury.

 A non-contact mechanism of injury to the MCL can occur in a variety of situations. Non-contact mechanisms for spraining the MCL include:

• When performing pivoting, cutting movements
• Landing from a jump, or leap
• Slipping your leg going out to the side relative to your body position.
• Or, getting your foot stuck when doing any of the above.

Yet again these mechanisms are common in the footballing codes, but also occur relatively frequently in the likes of skiing, basketball, netball… This movement action is medically termed “valgus” stress. Valgus stress to the knee, coupled with some external rotation of the lower leg places stretching strain onto the MCL. Where the ligament may fail if the stress applied is substantial enough.

Swelling A Clue To Injury With Medial Knee Pain

High speed, high energy sports can commonly injure more than just the MCL with the above mentioned mechanisms. It’s worth noting MCL sprains do not typically cause generalized swelling throughout the knee. An MCL sprain tends to cause local swelling. So, if you are experiencing any generalized swelling throughout the knee as a result of one of the above non- contact mechanisms it may indicate injury to other structures. Including the ACL, or meniscal tissue not just the MCL. The rule of thumb is, any twisting injury with an auidable “pop” sound in the knee, is considered an ACL injury till proven otherwise.

Rehab For Medial Knee Pain From MCL Injury

Rehab protocols for MCL injuries vary. Mainly in relation to the length of time taken, depending on the diagnosed grade of injury. Ideally a return to play can occur once;

• the individual is pain free,
• there is restoration of full range of movement,
• pre-injury dynamic balance control and strength has been restored
• and there is no subjective, or objective instability.

Return to play initially is usually carried out with supportive taping, or knee bracing. Utilized in an attempt to help protect the ligament and increase knee proprioception (as well as user confidence). Long term taping, or bracing following MCL injury is generally unnecessary.

From a healing standing point, remodeling of the medial ligament following injury can continue for up to one year. However, a return to play typically occurs considerably quicker than this. Following injury, a period of immobilization is often advisable for days-weeks. Following a period of immobilization, graduated movement is encouraged. Controlled progressive movement, functional loading and strengthening exercises help increase tissue healing strength.

ROM Bracing For MCL Injury

Due to the need to protect the healing ligament, patients with an MCL injury are frequently put into a hinged range of movement brace. ROM braces like this are utilized for a period of time to help protect the knee, allowing for supported mobility. The prescription of ROM braces with MCL injury is not 100% agreed on. With some surgeons preferring to protect the ligament during healing. Avoiding the over stretching of the ligament through restricted range of movement for a periods of weeks. Others being less concerned, firm about ROM bracing.

• My personal preference is, if the patient feels they can function with a ROM brace on. Then for any Grade 2-3 MCL injury, bracing with restricted end range flexion and extension is used for 3+ weeks as a starting point.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on MCL Injury: A Common Cause Of Medial Knee Pain should consult his or her general practitioner or physiotherapist or otherwise appropriately skilled practitioner.