Diagnosis

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With good physical examination, the Medial collateral ligament (MCL) injury is relatively easy to identify. However, to establish the extent and grade of injury, further investigations would be helpful. 

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X-ray. X-ray is performed and is useful to rule out any bone injuries. Ligaments are not visible on the X-ray. On occasions we See a small bone fragment pulled (avulsed) out on the inner side of the thigh or leg bone. When found, this represents the MCL ligament injury. This is called Segond fracture. 

MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the MCL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention.

 

Treatment

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First Aid for MCL injuries involves the typical R.I.C.E therapy for the first week.

Rest. It is important to minimize walking around.

Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling

Compression. Crepe bandage is sufficient to help with compression.

Elevation. Keeping it elevated on a pillow when resting helps.

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Conservative Management

 

MCL injury can be treated with Range of motion (ROM) knee brace in most patients. The angle of bending the knee is adjusted gradually. For the complete healing of the ligaments around 6 to 8 weeks of time is necessary. By 3 weeks, reassessment can help to understand the progress of the healing. 

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ACL + MCL Injury

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In patients with multi ligament injury, it is prudent to use ROM knee brace for 3 weeks. If MCL is healing naturally, then can proceed with the ACL reconstruction alone. If poor healing of MCL, then a decision to perform both MCL and ACL reconstruction may need to be taken. 

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Partial MCL Tears or Non-healing MCL tears

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Body will be trying actively to heal the ligament in the first 4 to 6 months. If satisfactory healing is not taking place in partial tears of MCL, then a PRP (Platelet Rich Plasma) injection can help to stimulate the healing process. 

 

MCL Surgery

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MCL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. Hamstring muscle tendon from the inner side of the thigh is used. The tendon is fixed to the thigh bone (femur) by using a biocomposite screw or titanium button and back to the leg bone (tibia) with a suture anchor made of either PEEK (high grade polymer) or biocomposite material

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MCL Rehabilitation

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Post-surgery, you are allowed to walk on the same day evening. You will need the ROM knee brace for upto 3 weeks. In patients with MCL surgery alone, can start walking with full weight on the leg from the day one. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 6 months before returning back to playing sports on the ground or court.

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