Medial Collateral Ligament (MCL) Injury

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A Medial Collateral Ligament (MCL) injury involves the stretching, partial tear, or complete rupture of the MCL, a ligament located on the inner side of the knee that helps stabilise the joint by preventing it from bending inward. MCL injuries are common in athletes, particularly those involved in contact sports.

Aetiology

MCL injuries typically occur due to:

• Direct impact to the outside of the knee, causing it to bend inward
• Twisting injuries, often associated with sports activities
• Sudden changes in direction or awkward landings during physical activity

Pathophysiology

The pathophysiology of MCL injury involves:

• Excessive valgus force applied to the knee, leading to overstretching or tearing of the MCL
• Inflammation and bleeding within the ligament, resulting in pain and swelling
• Potential involvement of other knee structures, such as the anterior cruciate ligament (ACL) or menisci, in severe injuries

Risk Factors

• Participation in contact sports such as football, rugby, and martial arts
• Previous knee injuries
• Poor conditioning or muscle imbalances, particularly in the quadriceps and hamstrings
• Sudden increases in physical activity or intensity
• Inadequate warm-up before exercise

Signs and Symptoms

The signs and symptoms of MCL injury include:

• Pain on the inner side of the knee
• Swelling and tenderness along the MCL
• Instability or a feeling of the knee giving way (in more severe injuries)
• Difficulty moving the knee, particularly when bending or straightening it
• Bruising around the knee in some cases

Investigations

Specific investigations to diagnose an MCL injury include:

• Clinical examination: Physical assessment of pain, tenderness, and stability using tests such as the valgus stress test.
• Imaging studies:
  • MRI: The preferred imaging modality to assess the extent of the MCL injury and any associated injuries to other knee structures.
  • Ultrasound: May be used to evaluate soft tissue injuries and assess ligament integrity.
  • X-rays: To rule out associated bone injuries such as fractures.

Management

Primary Care Management

• Rest and activity modification: Avoiding activities that exacerbate symptoms and allowing time for healing.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Ice application: Applying ice packs to the affected area to reduce swelling and pain.
• Compression and elevation: Using compression bandages and elevating the leg to limit swelling.
• Bracing: A knee brace may be recommended to stabilise the joint during the healing process.

Specialist Management

• Physiotherapy: Referral to a physiotherapist for a structured rehabilitation programme focused on restoring strength, flexibility, and stability.
• Surgical intervention: Rarely required but may be considered for severe or complex injuries, particularly if there is associated damage to other knee structures.
• Rehabilitation: Gradual return to physical activity through a supervised rehabilitation programme to ensure proper healing and prevent re-injury.

References

1. NHS (2024) Medial Collateral Ligament (MCL) Injury. Available at: https://www.nhs.uk/conditions/medial-collateral-ligament-mcl-injury/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Knee Injuries. Available at: https://cks.nice.org.uk/topics/knee-injuries/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Medial Collateral Ligament Injury: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2789 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Medial Collateral Ligament (MCL) Injuries. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/medial-collateral-ligament-mcl-injuries/ (Accessed: 24 June 2024).

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