One of the most commonly injured ligaments of the body is the medial collateral ligament (MCL) of the knee. The majority of MCL injuries are a result of force to the knee and is commonly seen with athletes that end up injuring the ligament due to twisting or bending of the knee in the wrong direction, or a sudden change in direction.
Proper equipment like knee braces in contact sports can help prevent an injury, but they are not commonly used prophylactically because it can hinder performance.
Despite the amount of MCL injuries, treatments can be successful by utilizing non-operative management with the majority of the injuries. Comparable results are found with both non-operative and operative management of the specific injury. Patients who may have a combined injury of the ACL and MCL can anticipate average stability with a fair to excellent outcome with the functionality of the separated ACL reconstruction alone.
Superficial MCL Reconstruction
A knee dislocation that results in injuring both lateral and medial sides of the knee may demand superficial MCL reconstruction with close to 85% of the patients. There is a small but compelling amount of patients that will continue to experience symptoms of instability, pain, or both, following the MCL injury and demand surgical reconstruction. The treatment of MCL injuries has continued to evolve over the years from being an aggressive type of surgical treatment, to one that is mostly non-operation management.
These surgeries usually only are reserved for those who suffer from chronic MCL deficiency, which can be the result of more complex injuries, or a nonoperative treatment that has failed. The majority of those who suffer from an MCL injury will generally obtain their pre-injury activity level by utilizing the non-operation treatment. The exception for this is with those who have combined ligament injuries, which may necessitate acute operative care.
Grades of Acute Isolated MCL Injuries
There are three different grades used in order to classify the severity of the MCL injury. For instance:
- Grade I – Involves only a few fibers being torn and can result in some tenderness.
- Grade II – Includes more fibers being disrupted with a generalized tenderness.
- Grade III – Is when there is a complete MCL tear.
A classification of grade I and II indicates an incomplete tear or injury, and is treated by utilizing non-operation management. This type of treatment mainly focuses on rest, compression, cryotherapy, and elevation during the acute phase. The primary goal for this type of injury is to reduce pain and the amount of swelling. The patient is allowed to put as much tolerated weight on the affected knee, but is required to wear a knee brace that hinges, in order to protect the knee from any type of additional stress.
In the early stages of the injury, early active range of motion is introduced in order to prevent stiffness for strengthening exercises. Once the patient’s proprioception and strength have recovered to a level comparable to the uninjured knee, they are then cleared to participate in their regular activities. A grade III classification is a complete MCL tear, and treatment for this type of injury is much more controversial compared to a grade I or II injury.
Research has provided thorough evidence to support both the operative and non-operative treatment procedures for grade II and III type of MCL injury. Originally, the operative treatment procedure was encouraged mainly due to inferior initial results of the non-operative treatment.
However, in subsequent comparison studies of both treatment methods, there were no objective or subjective differences found with the non-surgically and surgically managed groups, and many doctors tend to prefer the non-operative method with these types of isolated injuries. It is extremely important not to rule out any other ligament injuries to the knee and ensure that the MCL injury is definitely an isolated occurrence.
Combined Acute MCL and ACL Injuries
With a combination of both grade I or grade II classification for MCL and ACL injuries, in most cases the non-operative treatment method is still utilized, along with ACL reconstruction once the proper amount of knee motion has been achieved. The purpose of this treatment method when injuries to the MCL and ACL are combined is to avoid stiffness in the knee, and a delay with the reconstruction of the ACL can help reduce this type of complication.
For a combined MCL and ACL injury that is classified as a grade III, the MCL is still generally treated using the non-operative method, followed up with ACL reconstruction. With patients that have experienced this type of injury, the knee is set in a brace for six weeks, followed by strength and motion exercises once the MCL has had adequate time to heal.
However, if instability continues after the six week period with the brace, a surgical treatment will usually be recommended for the MCL, in combination with the ACL reconstruction. After reconstruction of the MCL and ACL, the patient is then made non-weight bearing while locked in extension. Approximately three weeks after the reconstruction procedure the Romberg test (ROM) is initiated to evaluate cerebellar function and balance.
While the MCL is the most commonly injured ligament of the knee, it continues to be a topic of emerging surgical, clinical, and rehabilitative research. With current knowledge and continuous research regarding the anatomy of the knee and treatment procedures, excellent outcomes have been reported for both the non-operative and operative treatment methods.
One of the top sports medicine doctors in Scottsdale and Phoenix is Dr. Sumit Dewanjee at FXRX. Dr. Dewanjee is Fellowship Trained in all types of simple and complex ligament reconstruction.
He is highly skilled in minimally invasive knee surgery with arthroscopic techniques. Most insurance is accepted, call (480) 449-3979 today!
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