Medial Ligament Injury A Common Cause Of Medial Knee Pain
Medial ligament (MCL) injuries are a common knee injury causing medial knee pain. MCL injury is something I see a lot in my clinic as I deal with a lot of soccer players and it is a very common football injury however not exclusively a soccer injury. Other football codes and skiing are also activities with a high risk of MCL injury.
Testing For A MCL Injury
Classically a MCL injury is classified by stress testing the ligament and feeling for pain and instability. An injury to the MCL is normally graded from 1-3 with a grade 1 injury being the most mild indicating a microscopic tear of the superficial and deep MCL with no resultant instability or laxity. A Grade 1 MCL sprain tends to have a much quicker recovery time than the most severe Grade 3 MCL injury, this injury being a complete tear of the MCL complex where stress testing the knee will typically pick up instability and a lack of a solid endpoint to the test.
MRI Imaging Can Help With Medial Knee Pain Diagnosis
Having an MRI can help with classification of MCL injury but findings on MRI don’t always correlate with what symptoms the patient is actually feeling. Assessment can be difficult in an acute MCL injury due to pain, swelling and a loss of motion meaning a MCL can be useful in this situation when it is felt assessment was impaired somewhat and/or other injures to the knee are also suspected. An ACL or meniscal injury can quite commonly occur in unison with a MCL injury so this always needs to be considered when assessing a suspected MCL injury.
Mechanism Of MCL Injury
MCL injuries are commonly caused in a couple of ways, one way is from direct contact to the outside of the knee while your foot is on the ground typically common in football codes. The other is non contact via simply what is termed a valgus stress to the knee with some external rotation of the lower leg when pivoting or doing cutting movements, again this mechanism is common in soccer but also common in sports like skiing and basketball or netball.
With high speed, high energy sports it is common to injure more than just the MCL with these above mechanisms. Worth noting is that a MCL injury doesn’t typically cause a generalized knee swelling, it tends to cause local swelling only so any generalized knee swelling from either of the above mechanisms will frequently indicate subsequent injury to other structures not just the MCL.
Rehabilitation Of Medial Knee Pain As A Result Of MCL Injury
Rehab protocol of MCL injuries vary mainly in the length of time taken depending on the grade of injury. Return to play can occur once pain free and restoration of full movement and strength without any instability. Return to play initially is usually carried out with supportive taping or knee bracing to help protect the ligament and increase knee proprioception and confidence. Long term taping or bracing with MCL injury is generally unnecessary.
Although remodeling of the MCL can continue after injury for up to one year return to play is considerably quicker than this.
Following injury a period of immobilization is advisable for days following this movement is then 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 do not result in any long term functional problems.
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.