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Medial Collateral Ligament (MCL) Tear. Development of MCL Tear. A valgus force to the knee while bearing weight can put enough stress on the MCL to tear it
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Development of MCL Tear • A valgus force to the knee while bearing weight can put enough stress on the MCL to tear it • Since the deep part of the ligament is damaged first and this portion inserts into the medial meniscus, there can be concomitant injury here
Symptoms of MCL Tear • There are three grades with different symptoms and severity • Grade 1 symptoms (stretched ligament) • Mild Tenderness on the inside of the knee • No swelling need be present • Pain on Valgus stress test but no laxity • Grade 2 symptoms (partial thickness tear of the ligament) • Significant pain in the medial aspect of the knee • Moderate swelling present • Valgus stress test will indicate moderate instability • Grade 3 symptoms (full thickness tear, or complete tear) • Varied amounts of pain • Significant joint laxity on valgus stress test • Complaints of instability (“wobbly” or “unstable” complaints) • These injuries can also include tears to the ACL
Differential Diagnosis Tests • Valgus stress test • Palpation of the medial aspect of the knee from medial femoral condyle to the medial tibial plateau • Slocum’s modified anterior drawer test • Anterior drawer test with external rotation • These help differentiate from Pes Anserine Tendinopathy and Bursitis issues
Recommendation • Time from injury, location, severity, and concomitant injuries will indicate need for surgery or if conservative treatment will be sufficient • Grade II injuries are treated initially with immobilization, R.I.C.E., and protected weight bearing • After swelling subsides then stretching, resistive exercise, and progressive weight bearing can be initiated • Grade I can begin second phase of grade II rehabilitation right away • Grade III tears require surgical intervention and referral to a doctor
Prognosis • Isolated grade I and II MCL tears respond well to conservative treatment and usually do not require surgical intervention • Most people in this group have no long term disability related to their injury • Grade III tears will require surgery for repair
References • Reider B. Medial collateral ligament injury in athletes. Sports Med. February 1996;21(2): 147-156. • Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. June 2006;14(2): 105-110.