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MCL Sprain

MCL or Medial Collateral Ligament Sprain Definition:
An MCL sprain is an injury sustained by the medial collateral ligament (MCL). This ligament is one of the four main ligaments that stabilize the knee joint. It is attached to the bottom of the femur (thighbone), runs down the inside of the knee, over the joint, and attaches at its other end to the top of the tibia (shinbone). Its role is to limit mobility of the knee joint and prevent it from opening up too far when subjected to pressure at the outside of the knee. The MCL is made of tough fibrous connective tissue that, when injured, can be torn, either partially or completely. This is known as an MCL sprain. Although it can be injured in isolation, often the meniscus and ACL are damaged at the same time.

Such sprains are graded according to the severity of the injury:
Grade I: The ligament has microscopic tears, but the joint is still stable.
Grade II: The ligament has been partially torn and there is a certain amount of instability in the joint.
Grade III: The ligament has been completely ruptured, either in the middle of the ligament, or torn away from one of the attachments to bone and the knee joint is completely unstable.

MCL Sprain Causes:
The most usual cause of a sprained MCL is force applied to the outside of the knee, which pushes the knee inwards and beyond its normal range of motion. This is an injury often sustained during contact sports.

Sprained MCL Symptoms:
The severity of any symptoms will increase with the extent of the injury. Grade I sprains will produce milder symptoms than a Grade III sprain.
  • Pain at the inside of the knee
  • Swelling
  • Instability of the knee joint
  • Perhaps a popping sound heard at the moment of injury
MCL Sprain Diagnosis:
Your doctor will ask you questions relating to the circumstances of the injury, the symptoms you are experiencing and your medical history. You will also have a physical examination during which your doctor will carefully examine the structures of your injured knee, and then compare it with the unaffected joint. If pain and swelling allow, your doctor might gently manipulate the knee joint to assess its stability and flexibility. You may also be asked to perform some movements yourself.

The medical history and physical examination are usually enough to diagnose an MCL sprain, but an x-ray image might be taken to rule out a bone fracture. Sometimes an MRI (magnetic resonance imaging) scan might be needed to better view the soft tissues of the ligaments.

MCL Sprain Treatment:
Injuries to the MCL usually respond to conservative treatment, and surgery is rarely required.

During the acute phase of the injury it is important to reduce any swelling and alleviate pain. This is achieved by:
  • Applying crushed ice, in a bag and covered with a towel, to the affected area. The ice pack should be kept in place for 15 minutes at a time, several times a day.
  • Resting the knee joint. Refrain from any activity that places stress on the joint, and perhaps use crutches to avoid placing weight on the leg.
  • Bracing. A knee brace may be recommended to prevent any further sideways motion of the joint in order to allow healing to begin.
  • Elevating the knee above the level of the heart, whenever possible.
  • Taking pain medication such as acetaminophen (Tylenol) or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve) or aspirin.
After the initial acute phase, and provided that no new pain or swelling is experienced as a result, you may be allowed to begin some gentle stretching exercises to restore mobility to the knee. Further exercises will be gradually introduced to strengthen the leg muscles that support the knee joint, thereby helping to prevent further injury. Stationary bicycle riding may also be helpful in rehabilitation.

Ultrasound may be used on the knee by a physiotherapist: It is thought that this technique assists with the formation of healing scar tissue.

MCL Sprain Rehab: Exercises:
Any exercise should only be undertaken with the permission of your health care practitioner. Stop exercising if you experience any pain.
Flex and extend:
Sitting, standing or lying on your stomach, gently bend and straighten the knee as far as you can without pain. One set is 10-20 repetitions; build up to 3 sets, 3 times a day.
Heel slide:
Lying on your back, bend the injured knee and keep the foot on the floor. Slide the heel towards the buttocks as far as you can without pain. Repeat 10-20 times.
Quad stretch:
Hold the right foot with your right hand and gently pull the foot up and behind you towards the buttocks, stopping when you feel a stretch. Keep your knees together. Hold the stretch for 10 seconds then relax. Switch legs and repeat exercise.
Hamstring stretch:
Standing, place one leg slightly in front of the other. Bend the back knee and keep the front knee straight. Keeping your weight on the bent knee, lean forwards until you feel a stretch in the back of the thigh. Hold the stretch 5-10 seconds then relax. Switch legs and repeat exercise.

Your doctor will recommend the most appropriate knee brace for you to wear during recovery and rehabilitation. Often this is a lightweight hinged knee brace that can be set to allow for a gradual increase in range of motion as the MCL heals.

A different brace may be recommended as you return to full activity, particularly sports, in order to provide support and protection for the knee. When in the brace the knee can flex and extend, but not move sideways. It should be properly fitted so that it feels comfortable yet firmly supportive. It should not cause any swelling below the knee, or any feeling of constriction.

Prognosis and recovery time:
The outlook for an MCL sprain is usually very good. A mild sprain may take anything from a few days to two weeks to repair, a grade II sprain can take up to four weeks, and a severe sprain anywhere from four to eight weeks, but full recovery with minimal long-term effects is highly likely.

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