What Is A Knee Ligament Injury
Knee ligaments are the short bands of tough, flexible connective tissue that hold the knee together. Knee ligament injuries can be caused by trauma, such as a car accident. Or they can be caused by sports injuries. An example is a twisting knee injury in basketball or skiing.
The knee has 4 major ligaments. Ligaments connect bones to each other. They give the joint stability and strength. The 4 knee ligaments connect the thighbone to the shin bone . They are:
- Anterior cruciate ligament . This ligament is in the center of the knee. It controls rotation and forward movement of the shin bone.
- Posterior cruciate ligament . This ligament is in the back of the knee. It controls backward movement of the shin bone.
- Medial collateral ligament . This ligament gives stability to the inner knee.
- Lateral collateral ligament . This ligament gives stability to the outer knee.
How Are Tears In The Medial Collateral Ligament Diagnosed
Your doctor will 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 injured knee will be checked for pain or tenderness. Pressure will be put on the outside of the 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.
- 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 1 centimeter when the doctor moves your leg around. A grade 3 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 scan. An MRI has an accuracy rate of nearly 90 percent in determining whether and how badly a medial collateral ligament tear is.
Symptoms Of Mcl Tear:
In this section, we will go over the symptoms of MCL Tear in-depth:
1. A popping sound when the injury occurs:
The popping sound happens with the slight tearing of the medial collateral ligament in the knee. This typically happens when a person is landing with their leg extended. The sound can also be heard during twisting and turning movements that involve the knee.
2. Immediate sharp pain from the inner section of the knee:
The MCL tear is a tear in the middle of the medial collateral ligament of the knee. It is a common injury that can be caused by any trauma, such as falling or twisting the knee. The pain usually starts on the inside of your knee and then spreads to other parts of your leg. It is sharp and immediate, but it also fades over time. The pain can be felt in the inner section of the knee, just below the kneecap.
3. Immediate swelling at the inner knee:
An MCL tear is a disorder in which the medial collateral ligament of the knee is torn. It causes swelling at the inside of the knee and pain when you bend or straighten your leg. It can be due to a fall on an outstretched hand or hyperextension of the knee, or it can be due to repeated stress on the knee joint over time.
4. Tenderness around the inner knee:
5. Increased pain a few hours after the injury:
This pain usually decreases over time, but it can return again with an increase in intensity if more force applies to the knee joint.
6. Bruising around the knee:
7. Noticeable looseness in the knee:
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What Is Medial Collateral Ligament Injury
The medial collateral ligament 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 , and the medial and lateral collateral ligaments .
The MCL spans the distance from the end of the femur to the top of the tibia 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.
Because the MCL resists widening of the inside of the knee joint, the ligament is usually injured when the outside of the knee joint is struck. This force causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of clipping in a football game.
An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus, may be torn along with a MCL injury.
How Is An Mcl Injury Treated
Most MCL injuries can be treated at home with rest, ice, and anti-inflammatory medicine. Your doctor may suggest that you use crutches and wear a brace that protects but allows for some movement of your knee.
You may need to reduce your activity for a few weeks. But doing gentle movement as advised by your doctor will help you heal.
Your treatment will depend on how severe your injury is.
- Mild or grade 1 injuries.
- These injuries usually get better in 1 to 3 weeks and may only need home treatment along with using crutches for a short time.
- Moderate or grade 2 injuries.
- These injuries usually get better in about a month. You may need to wear a hinged knee brace and limit how much weight you put on your leg.
- Severe or grade 3 injuries.
- These injuries may require wearing a hinged brace for a few months, and limiting weight on the leg for 4 to 6 weeks.
Your doctor may recommend physiotherapy to increase range of motion and strengthen your quadriceps muscles and hamstrings.
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What Can I Do To Prevent An Mcl Tear
While not all MCL tears are preventable, there are steps you can take to lower your risk of tearing your MCL. Balance, strength and power exercises that focus on your thigh and hip muscles can help lower your risk of getting an MCL tear. In football linemen, braces have been shown to prevent MCL injuries.
Treatment Of Knee Sprains
JOI physical therapy can help with knee sprain recovery
For ACL and MCL sprains or tears, a patient must see an orthopedic specialist for further evaluation. The ACL and MCL are treated very differently in the orthopedic field. Both injuries are initially treated with ice, crutches, and immobilization. The ACL often requires surgery for the more severe sprains. The MCL does not usually require surgery unless it involves other ligaments or a complete rupture. At JOI, we have precise treatment protocols for both injuries. This article was focused on the difference between an ACL and MCL tear. However, often a more severe knee injury involves both of the ligaments. Watch this VIDEO about Why Knee Pain Can’t Wait.
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What Is Mcl Surgery Recovery Time
In the acute medial knee ligament tear situation, patients are placed into a brace and are enrolled in an early rehabilitation program to emphasize quadriceps reactivation, edema control and knee range of motion. The main rehabilitation exercise for MCL tears is the frequent use of a stationary bike.
For isolated acute MCL injuries, most athletes can return to sports by multiplying the grade of the injury by two as a general time frame. Thus, a grade I acute MCL injury usually needs 1-2 weeks to heal, while a grade II injury takes 3-4 weeks to heal and a grade III isolated complete MCL injury typically takes 5-6 weeks of properly guided rehabilitation to have the injury heal completely.
The use of a hinged MCL protective knee brace is also commonly recommended in the acute situation when the knee is significantly unstable. Thus, we recommend the patient be fitted by one of our brace specialists. They will properly fit the MCL brace, which is durable enough for desired activity levels.
Causes Of Medial Collateral Ligament Injury
An MCL injury is usually caused by your knee being pushed inwards . This may happen if you have a direct blow to the outside of your leg, which can happen during sports such as rugby. You can also injure your MCL by twisting your knee for instance, in skiing, or from repeated stress on your knee such as in breast stroke when swimming. You can also injure the MCL if you fall.
You can access a range of treatments on a pay as you go basis, including physiotherapy. Find out more about physiotherapy >
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Will An Mcl Injury Heal Itself
Many MCL injuries do have the ability to heal. This is especially true if the MCL is the only ligament torn around the knee. Partial MCL tears almost always heal, while complete MCL tears mostly heal. The MCL tears that are most concerning about whether they heal or not are those that occur with other ligament injuries in the knee, especially with the PCL, when the chance of healing for a complete MCL tear is low. In addition, MCL tears that completely tear off the femur and the knee gaps open on the inside with the knee out straight or when the MCL tears off its distal attachment on the tibia, are the main types of MCL tears which do not heal.
MRI scan demonstrating a tear of the medial collateral ligament off the femur. Tears off the femur, especially those with a knee that does not gap open when the knee is tested in full extension, have a higher chance of healing compared to MCL tears off the tibia.
Causes Of An Mcl Knee Sprain Or Tear
Typical causes of this sprain are:
- direct contact in sports
- knee undergoes a twisting motion
It is typically referred to as anMCL sprainand classified based on the degree of damage ranging from first to third degree.
One major difference between an ACL and an MCL tear is that an ACL tear usually has significant swelling. Another difference between an ACL and an MCL tear is the amount of instability with walking. With an ACL tear, the patient will need crutches and braces to walk.
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Differences Between The Acl And Mcl Tears
Four major ligaments stabilize the knee. The MCL, or Medial Collateral Ligament, is located on the inside of the knee. It attaches the thigh bone to the shin bone. The ACL, or Anterior Cruciate Ligament, is a ligament connecting the upper leg bone with the lower leg bone. It keeps the knee stable. This article will discuss the difference between ACL and MCL tears. If you want to learn more about the ACL, you can watch this video.
Image of the ACL and MCL Ligaments
What Is The Difference Between An Mcl Injury Or Arthritis
In patients who have arthritis, it may be difficult to determine if they have a partial MCL tear or just an exacerbation of their underlying arthritis because of some of the toggle that can occur at the joint line with a loss of cartilage. This is called pseudolaxity. In these cases, the knee can toggle side to side and it can be very difficult for the examiner to determine with ones fingers if the gapping is due to an MCL tear or an exacerbation of the underlying arthritis when one does have an injury. In these circumstances, obtaining x-rays to see if there is any significant joint line narrowing or if there are concerns about a concurrent MCL tear, obtaining bilateral valgus stress x-rays to see if there is a side-to-side difference in medial compartment gapping may be indicated. In any circumstance, it can be difficult for physicians to determine the difference between the two conditions and x-rays may be indicated to help arrive at a diagnosis.
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Symptoms Of A Meniscus Tear Or Mcl Sprain
Depending on the grade of severity, a sprained MCL can result in varying symptoms.
- Grade I: mild tenderness over the inside of the knee with minimal swelling
- Grade II: more pain and swelling on the inside of the knee and more likely to display instability
- Grade III: MCL ligament ruptures or tears completely, with significant swelling in the knee, difficulty bending the knee, and instability.
If you want to learn more about the Knee Anatomy, please watch this Knee Anatomy Video.
How Does A Posterior Cruciate Ligament Injury Affect My Body
A PCL injury can cause mild, moderate or severe damage. Healthcare providers rate posterior cruciate ligament injuries in four different categories:
- Grade I. A partial tear is present in the ligament.
- Grade II. Theres a partial tear and the ligament feels loose.
- Grade III. The ligament is completely torn and the knee is unstable.
- Grade IV. The PCL is injured and another knee ligament is damaged.
People with posterior cruciate ligament injuries may have short- or long-term symptoms. Typically, long-term symptoms occur when an injury slowly develops over time.
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What Are The Surgical Treatments How Is The Surgery Done
Surgery to reconstruct a torn ACL is done with a graft of a tendon from your body, such as a hamstring , or the kneecap/patellar tendon . Occasionally, a cadaver tendon can be used in older individuals who are still very active. Cadaver tendons are typically not used in young athletes because of the higher rates of re-tear.
The surgery is minimally invasive, which means that instead of making a large incision with a scalpel, the surgeon uses an arthroscope, a thin wand-like instrument. The surgeon inserts the arthroscope and the working instruments through small incisions in your knee.
What Are Knee Injury Symptoms And Signs
Acute knee injuries can cause pain and swell with difficulty bending the knee and weight-bearing. Acute knee injuries often may be considered as falling into two groups: those where there is almost immediate swelling in the joint associated with the inability to bend the knee and bear weight, and those in which there is discomfort and perhaps localized pain to one side of the knee, but with minimal swelling and minimal effects on walking.
If the swelling occurs immediately, it may suggest a ligament tear or fracture. If the swelling arises over a period of many hours, meniscal or cartilage injuries may be the cause. However, injuries to the knee may involve more than one structure and the symptoms may not present classically.
Longer-term symptoms that point to knee problems will include pain and swelling in addition to other complaints. Inflammation in the joint may be caused by even minor activity. Swelling may be intermittent, brought on by activity, and may gradually resolve as the inflammation decreases.
Pain, too, may come and go. It may not occur right away with activity but might be delayed as the inflammation develops. Pain can also be felt with specific activities. Pain while climbing stairs is a symptom of meniscus injury, where the cartilage is being pinched in the joint as the joint space narrows with knee bending. Pain with walking downstairs suggests patellar pain, where the kneecap is being forced onto the femur.
What Causes An Mcl Tear
Sudden and forceful turning, twisting and cutting can cause MCL tears. A direct blow to the outer side of your knee can also cause an MCL tear. MCL tears are most common in people who play certain sports like skiing, football, basketball and volleyball.
The following situations can cause an MCL tear:
- Planting one foot into the ground and forcefully shifting direction .
- When something or someone hits your knee on its outer side, such as from a football tackle.
- Squatting or lifting heavy objects.
- Landing awkwardly on your knee after a jump.
- Hyperextending your knee. This is common in skiing.
- Repeated pressure and stress to your knee, which causes your MCL to lose its elasticity .
Recovering From An Mcl Injury
Whether MCL surgery is needed or not, the outlook for recovery after a tear is very good. However, recovery times will depend on the severity of the injury and the treatment option youre prescribed.
Its important to follow the guidance of your orthopaedic surgeon and/or physical therapist throughout the recovery period to ensure that your knee heals properly and to prevent further injury.
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