The knee is made up of four very important ligaments: the ACL (anterior cruciate ligament, PCL (posterior cruciate ligament), LCL (lateral collateral Ligament and the MCL (medial collateral ligament). Today we are going to take a closer look at the MCL.
The MCL originates at the medial portion of the femur near our knee (above the joint line) and attaches at the shin bone (tibia) close to the knee on the inside (below the joint line). It is made up of fibrous connective tissue that attaches bone to bone and is outside of our joint.
Our MCL helps us avoid too much valgus stress, or in other words, inward force on our knees.
With contact having the highest result of an MCL failure, planting with a slight bending of the knee with the foot pointed outward can be another cause. It is used when people are bending (flexing), changing directions, and twisting. All of these can be used in daily living activities and sports activities.
During activities you may plant your foot and have a force push your knee toward your midline. The next question you ask yourself: Is my MCL OK? When ligaments are injured, they are sprained meaning they were stretched beyond their limit. Look for any swelling in the area, tenderness on the medial knee, and most importantly did you hear a popping sound. Deciding on the degree you have these signs will help us diagnose what grade of sprain you may have.
There are three different grades of a sprain.
A Grade 1 sprain is a slight pull of the ligament past its end point. This will feel almost as though you were stretching and went too far. You can tell a grade 1 by tenderness to the touch, slight swelling and stiffness of the joint going into motion. Since the ligament is still intact there is no instability of the medial aspect of the knee. When looking at how long it takes to heal, it varies from roughly a few days to a week and a half.
With a Grade 2 sprain there is moderate pain that occurs at the ligament, with swelling, and ecchymosis (bruising) at or around the ligament. Movement is not only stiff, but it is painful. With a Grade 2 MCL sprain, walking would be difficult to perform. It takes the healing process anywhere from 2-4 weeks to heal during this degree of injury.
Grade 3 sprains are a complete tear of the ligament due to enormous force in a certain direction. There is excessive swelling and bruising around and at the ligament. With a Grade 3 sprain there will be permanent instability. Meaning there is laxity in the ligament. There is no need for surgery with a grade 3 ligament sprain, but the recovery process can be lengthy at 6-8 weeks.
After the mechanism of injury, there are five signs that will show heat, redness, swelling, pain and loss of function.
Since these signs start to occur almost immediately, we must compress and ice to reduce further complications. Once the inflammation has started cells known as neutrophils start to get rid of the damaged cells. The proliferative stage begins 48 hours after injury has occurred. Macrophages release a growth hormone to allow for the increase of the rehabilitation process. The remodeling phase is the last step to the healing process and starts at 1-2 months after injury.
The damaged tissue is replaced by scar tissue but must be stressed with rehab so that it lays down properly. Strengthening all the muscles around the knee and providing stability is the main goal. A supportive brace can help when performing daily living activities protecting you against any excessive knee valgus.
Be aware of the motions you perform throughout your daily life and if there are any major concerns seek the advice of your medical provider.