Medial collateral ligament (MCL) sprain

Medial or tibial collateral ligament (ligamentum collaterale medialis, MCL) is a passive stabilizer of the medial knee shift or collapse, ie. it counteracts to the forces that push the knee inwardly and in that way it prevents the knee valgus stress or collapse. Its origin is the distal medial part of the femur (epicondylus femoris medialis) and its connecting place is the medial proximal part of the shin bone (condylus medialis tibiae).

Commonly MCL injuries occur due to muscle strenght deficits in the different parts of the quadriceps muscle (lateral part is stronger than the medial part) or strenght deficits in the anterior and posterior upper leg muscles (hamstrings weaker than quadriceps). Anatomical deformities of the knee (valgus position) or foot (excesive foor pronation, internal collapse of the foot), being overweight, the position of the pelvis (a more open pelvis with the female population as an adaptation to giving birth, which then consequently causes the valgus position of the knee) can all be risc factors for MCL injuries. The most common injury mechanism is a valgus knee stress/collapse, with the knne slighty bent, obtained through a contact or non-contact situation. It happens during landing, lunging diagonally or forward or change of direction where the biomechanics of the movement is impaired, ie. the knee is not aligned properly with the foot, the hip and the shoulder which leads to valgus collpase of the knee and MCL injury which depending on the force that affected the knee can vary in its gravity and be either a single injury or combined with injuries to other ligaments and soft tissue in the knee joint. MCL injuries are common occurences in sports like skiing, football, soccer, voleyball, with breaststroke swimmers (due to the specific foot/knee positioning), etc.

Degrees of MCL injury:

1. Strained MCL – the smallest degree of injury , ligamnet tissue does not tear, rehabilitation last up to 1 month

2. Partial MCL rupture -  ligament tissue tears partially, rehabilitation lasts 2-3 months

3. Complete MCL rupture – the most severe MCL injury, rehabilitation lasts cca. 4 months

Treatment of an MCL injury depends on its gravity/degree of injury, with more difficult injuries a surgical apporach is needed (complete MCL tear) and with a lower degree of the injury a conservative apporach can be used. It should be stated that due to the fact that the MCL is a ligamnet that has the ability to heal on itself in certain cases, ie. partial MCL rupture, immobilization was used in order to let the ligament heal on itself. In acute therapy phase RICE method (rest, ice, compression, elevation) is used to reduce pain, swelling and hematoma. In the functional phase a progressive and careful approach to regaining knee joint range of motion should be implemented, especially flexion because the MCL can get reinjured during knee flexion. Progressive strenghtening of upper leg muscles, with an accent on proper quadriceps activation, developing strenght of the medial part of the quadriceps muscle and hamstring strenght, as well knee joint stability exercises should be integral parts of the functional therapy.

Prevention: treatment of antomical defomities and changes in the knee/foot (use of orthopaedic foot pads and strenghtening of the medial quadriceps part), preventive strenghtening and balance programs with populations that have a greater risk of MCL injury (people with valgus knee position, female population due to the pelvis position, athletes in sports which put added stress on the medila knee region during training), maintaining a balanced body weight, etc.