Medial Collateral Ligament (MCL) Knee Injury

MCL Knee Injuries:

A common injury for contact sport athletes is an injury to the Medial Collateral Ligament (MCL) of the knee. It is one of the key ligaments that helps keep your knee stable. It is located on the inside of the knee and connects your femur (thigh bone) to the tibia (shin bone). Here at Unbreakable Physiotherapy in Moorabbin our Sports Physiotherapists are very experienced with MCL injuries and are here to help!

The MCL is made up of two parts described as deep and superficial. The superficial component is larger and helps stop the knee from bending inwards (valgus stress) and helps keep the knee from twisting too much when it is slightly bent. The deep component lies underneath and helps connect the above bones to the medial meniscus. It also helps control twisting the knee in both bent and straightened positions. These two components work together to stop the knee moving in ways it shouldn’t- especially with buckling inward or twisting too far.

When an athlete has suffered an injury to the inside of their knee, it is important to consider how the injury has occurred- whether it was caused by a collision/direct hit to the outside of the knee (contact) or from a sudden twist or movement (non-contact). Majority of MCL injuries occur from a contact mechanism of injury. This is common in sports like football, basketball or rugby.

MCL injuries can be classified into three grades based on how much the ligament is stretched or torn:

• Grade 1: Mild injury- some pain but the knee is stable
• Grade 2: Moderate injury- more pain and minor instability within the joint. The ligament is still partially intact
• Grade 3: Severe injury- the ligament is fully torn; the knee feels unstable

The location of the injury within the ligament is also important. If the injury is lower down towards the shin bone, recovery can take longer because this area has a thinner attachment. For moderate to severe MCL injuries, a knee brace is usually used. Restrictions can be put on how much the knee can bend and straighten to help protect the ligament as it is healing. MRI scans are commonly used to confirm diagnosis of MCL injuries and identify if any other surrounding structures have been injured.

There are 5 key rehabilitation phases following an MCL injury.

1. Protection

• Primary goal is to create the best environment for the ligament to heal properly. This may mean wearing a knee brace for higher grade injuries
• Manage pain and reduce swelling- compression, ice, ankle pumps (moving foot up and down)
• Get the quadriceps working again- exercises include inner range quadriceps contraction, banded terminal knee extensions
• Maintenance of other lower limb muscles- exercises that focus on keeping the strength of hamstring, calf and foot
• Improve balance and control, especially on one leg and control at the hips
• Stay active to maintain overall fitness without placing emphasis on the knee- upper body conditioning sessions

2. Load Introduction
   • Build on foundations made in the protection phase
   • Increase the difficulty of strength exercises
   • Shifting towards more one-leg (unilateral) exercises that mimic activities during their chosen sport
   • Introduce light jumping (plyometrics) and controlled running drills
   • Improve range of movement, more applicable if have been in a brace
3. Strength Accumulation
   • Big emphasis on helping the athlete safely return to running
   • Build up running distance
   • Add speed and planned changes of direction
   • Introduce unplanned changes of direction
   • Progress plyometric exercises- shifting towards bigger and further jumps in different directions
4. Training Integration
   • Return to contact work and skill demands of their sport
5. Return to Performance

The time spent in each phase is athlete dependent and progressing from one phase to the next will be guided by your Physiotherapists and specific tests.

If you have been diagnosed with an MCL injury or have injured your knee and unsure of what to do next – book an appointment today with one of our experienced Sports Physiotherapists at Unbreakable Physiotherapy in Moorabbin.