Medial Ligament Injury A Common Cause Of Medial Knee Pain
Medial ligament (MCL) injuries are a common knee injury and cause medial knee pain. A MCL injury is something I see a lot of in my Sydney physio clinic as I deal with a lot of soccer players spraining your medial ligament is a very common (however not exclusively) soccer injury. Other footballing codes and also skiing are other activities that have a relatively high frequency of participants suffering a MCL injury.
Assessing An MCL Injury
In a physio practice a medial ligament injury is graded by stress testing the ligament and assessing for pain and instability. An injury to the medial ligament is classically graded ranging from grades 1-3, with a grade 1 injury being the most mild sprain indicating a microscopic tear of the superficial and deep MCL with no resulting instability or laxity on stress testing. Grade 1 MCL sprains tend to have a much quicker recovery time than the more severe Grade 2 or 3 MCL injury, A Grade 3 injury is a complete tear of the MCL complex where on stress testing the knee the treating physio will typically pick up instability and the a lack of a solid endpoint to the test. A Grade 2 medial sprain therefore fills the gray space between the minor and stable Grade 1 tear and the unstable complete rupture that is a Grade 3 medial sprain.
MRI Imaging Can Assist Medial Knee Pain Diagnosis
In the presence of an acute trauma/injury 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 meaning grading injury severity can sometimes be difficult, in these situations an MRI may be considered. An MRI can be useful if assessment was impaired for one reason or another, or if damage to other structures of the knee are suspected like fracture or ACL rupture. ACL or meniscal injuries quite commonly occur in unison with an MCL injury so these alternative or concurrent injuries needs to be considered when assessing a suspected MCL injury. Having an MRI can help with the classification of MCL injury but remember no investigation can assess for pain so findings on MRI don’t always correlate with the symptoms the patient is actually feeling.
What Are The Mechanics Behind An MCL Injury?
MCL sprains are commonly caused in a couple of ways, one way is from direct contact to the outside of the knee while your foot is planted on the ground, this type of injury is particularly common in the football codes. Another mechanism of injury to the MCL is via a non contact injury, this sort of injury can occur when pivoting, performing cutting movements, landing from a jump or leap, slipping or getting your foot stuck when doing any of the above. Yet again this mechanism is common in the footballing codes, but also occurs relatively frequently in the likes of skiing, basketball or netball. The stress to the knee here is medically termed a “valgus” stress to the knee and is coupled with some external rotation of the lower leg putting stretching strain to the MCL.
High speed, high energy sports can commonly injure more than just the MCL with these above mechanisms. It is worth noting that an MCL sprain doesn’t typically cause generalized knee swelling throughout the whole knee. An MCL sprain tends to cause local swelling only, so if you are experiencing any generalized knee swelling throughout the knee as a result of one of the above mechanisms of injury this may indicate subsequent injury to other structures like the ACL or meniscal tissue not just the MCL. As a rule of thumb any twisting injury with an auidable “pop” sound is an ACL injury till proven otherwise.
Medial Knee Pain Rehab For An MCL Injury
Rehab protocols for MCL injuries vary mainly in 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 to help protect the ligament and increase knee proprioception as well as confidence. Long term taping or bracing following MCL injuries 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 can typically occur considerably quicker than this. Following injury a period of immobilization is often advisable for days to weeks and following this period of immobilization graduated movement is encouraged. Controlled movement and strengthening exercises help increase healing strength but due to the need to protect the healing ligament patients with an MCL injury are frequently put into a hinged knee brace for a period of time to help stabilize the knee yet allow supported mobility. Complete grade 3 tears do not typically require surgery and generally MCL tears causing acute medial knee pain will not result in any long term functional problems once healed.
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.