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MCL SPRAIN
What is it?
The medial collateral ligament is one of the main ligaments located on the medial aspect of the knee that acts to maintain its stability. The MCL originates at the distal end of the adductor tubercle and inserts approximately 6 cm below the joint line. There is a deep and superficial layer to the MCL. The deep layer is attached to the medial meniscus and the superficial layer is a strong triangular strap. MCL sprains are often associated with other injuries to the knee, though the MCL is the most commonly injured ligament, usually occurring at the site of its origin.
It hurts where?
Athletes will have pain located at the medial aspect of their knee, either from the origin to the insertion, depending on the location of the sprain. Since most injuries to the MCL occur at the origin, there will be pain around that region as well as along the medial joint line. Painful gait may be observed. The injured area will be sensitive to touch and will be bothersome with knee extension and tibial external rotation. If there is pain with flexion, it may be associated with a meniscal or capsular injury.
How does it happen?
There are several mechanisms of injury for a sprained MCL. The most common mechanism of injury is a direct blow to the lateral side of the knee while the foot is planted. This causes what is known as a Valgus force. While most MCL injuries occur when contact with the ground is made, it may occur without contact by a forced external rotation of the tibia, typically seen in skiers. A valgus force to the knee with the foot in excessive external rotation unloaded may also act as a mechanism. MCL sprains can occur with other associated injuries, such as ACL/PCL tears and meniscal injuries.
Similar injuries
Assessing an injured MCL is determined upon evaluation with emphasis placed on history, palpation, and stress tests. Differential diagnosis of MCL injuries must be made to rule out other significant injuries with similar mechanisms of injury. Other similar injuries include contusions, usually associated with direct contact to the (medial) knee without the foot being planted, injuries to the meniscus, capsular injuries, and ACL sprains that are associated with similar mechanisms. ACL sprains are commonly associated with MCL sprains. Meniscal injuries can accompany MCL sprains either from distraction on the medial side or compression on the lateral side. Special tests will help determine this.
Treatment
Initial treatment upon evaluation is immediate care for pain and swelling. As with all acute injuries, ice, compression, and elevation are essential. Electric stimulation may be used to assist in decreasing pain as well. Other treatments later in progression may include ultrasound and heat, based upon the athletic trainer's preference. The most important aspect of treating this injury is rehabilitation. Isolated MCL tears are treated non-surgically. Rehab focuses on decreasing swelling, maintaining range of motion (particularly flexion), and strengthening the musculature around the knee. Each rehab program will differ upon the severity of the sprain. Strengthening exercises should not be started until range of motion is resolved and swelling has decreased significantly. Time off will be necessary depending on severity and progression through rehab.
Participation Status
Return to activity is dependant on the severity of the MCL sprain. Progression through rehab along with pain levels will also determine when an athlete is permitted to return to participation. An athlete should be functionally tested to make sure drills such as cutting and pivoting will not cause further injury. With a grade I MCL sprain, athletes will return to full play after up to 10-14 days. Grade II MCL sprains will keep athletes out of play for about 3 weeks and grade III sprains will keep athletes out for an average of 5 weeks. Each athlete is different with progression and if progression is slow, re-evaluation for other injuries is necessary.
MCL TEAR
What is it?
The menisci are two oval shaped pieces of cartilage that sit in the knee joint and cushion any stress placed on the joint. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other. The "Medial Meniscus" sits on the inside of the knee and the "Lateral Meniscus" sits on the outside. The medial meniscus is C-shaped and the lateral meniscus is an O-shape. The outer 1/3 of the menisci have a good blood supply, but as you go to the inside, the blood supply becomes less. Depending on the mechanism of injury, the type and placement of the tear will be different.
It hurts where?
If you tear your meniscus, your pain will be in the area of the tear. It will be along of the knee joint line, which is where the femur and the tibia come together. The tear can be in the front of the knee, the back or even the sides but it is always located at the joint line.
How does it happen?
A meniscus tear may be caused by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament) or MCL (medial collateral ligament). A meniscal tear is usually a non-contact injury.
Injury Progression
A meniscal tear will usually present with a pocket of swelling directly where the tear occurred. If you continue to play without treatment, the entire knee joint may swell or a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock-your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it to unlock. At this point, surgery is the most likely option to get you back to play.
Similar injuries
Meniscal tears can be confused with a few different things. One is a gastrocnemius tear at its origin at the back of the knee. Another is a hamstring tendon strain also at the back of the knee where the hamstring tendons cross right before they attach below the knee joint. Ligament tears may also be confused with a meniscal tear or may be associated with one. It is not uncommon to tear the medial meniscus when you tear your MCL or ACL or even both.
Treatment
The treatment of a meniscal tear will begin with ice, electric stimulation and rest. A visit to the orthopedist usually happens next with an MRI being prescribed. If there is a tear, it will show up on the films, in most cases. If the tear cannot heal on its own, surgery may be the best option. Rehabilitation exercises will help strengthen the musculature and help stabilize the knee. A very small percentage of meniscal injuries can be treated through rehab and without surgery for athletes. Occasionally, an athlete can postpone the surgery until the season is completed, depending on the severity of the tear.
Participation Status
Most people cannot participate at the varsity athletic level with a meniscal tear. Some people are able to if the tear is small and there is little swelling associate with it. Many people experience a popping, clicking and/or locking sensation that is painful or too irritating to continue to play. Once the tear has been fixed or removed it will take 3-6 weeks of rehab to get back into play, it is not necessarily a "season ending injury."
What is it?
The medial collateral ligament is one of the main ligaments located on the medial aspect of the knee that acts to maintain its stability. The MCL originates at the distal end of the adductor tubercle and inserts approximately 6 cm below the joint line. There is a deep and superficial layer to the MCL. The deep layer is attached to the medial meniscus and the superficial layer is a strong triangular strap. MCL sprains are often associated with other injuries to the knee, though the MCL is the most commonly injured ligament, usually occurring at the site of its origin.
It hurts where?
Athletes will have pain located at the medial aspect of their knee, either from the origin to the insertion, depending on the location of the sprain. Since most injuries to the MCL occur at the origin, there will be pain around that region as well as along the medial joint line. Painful gait may be observed. The injured area will be sensitive to touch and will be bothersome with knee extension and tibial external rotation. If there is pain with flexion, it may be associated with a meniscal or capsular injury.
How does it happen?
There are several mechanisms of injury for a sprained MCL. The most common mechanism of injury is a direct blow to the lateral side of the knee while the foot is planted. This causes what is known as a Valgus force. While most MCL injuries occur when contact with the ground is made, it may occur without contact by a forced external rotation of the tibia, typically seen in skiers. A valgus force to the knee with the foot in excessive external rotation unloaded may also act as a mechanism. MCL sprains can occur with other associated injuries, such as ACL/PCL tears and meniscal injuries.
Similar injuries
Assessing an injured MCL is determined upon evaluation with emphasis placed on history, palpation, and stress tests. Differential diagnosis of MCL injuries must be made to rule out other significant injuries with similar mechanisms of injury. Other similar injuries include contusions, usually associated with direct contact to the (medial) knee without the foot being planted, injuries to the meniscus, capsular injuries, and ACL sprains that are associated with similar mechanisms. ACL sprains are commonly associated with MCL sprains. Meniscal injuries can accompany MCL sprains either from distraction on the medial side or compression on the lateral side. Special tests will help determine this.
Treatment
Initial treatment upon evaluation is immediate care for pain and swelling. As with all acute injuries, ice, compression, and elevation are essential. Electric stimulation may be used to assist in decreasing pain as well. Other treatments later in progression may include ultrasound and heat, based upon the athletic trainer's preference. The most important aspect of treating this injury is rehabilitation. Isolated MCL tears are treated non-surgically. Rehab focuses on decreasing swelling, maintaining range of motion (particularly flexion), and strengthening the musculature around the knee. Each rehab program will differ upon the severity of the sprain. Strengthening exercises should not be started until range of motion is resolved and swelling has decreased significantly. Time off will be necessary depending on severity and progression through rehab.
Participation Status
Return to activity is dependant on the severity of the MCL sprain. Progression through rehab along with pain levels will also determine when an athlete is permitted to return to participation. An athlete should be functionally tested to make sure drills such as cutting and pivoting will not cause further injury. With a grade I MCL sprain, athletes will return to full play after up to 10-14 days. Grade II MCL sprains will keep athletes out of play for about 3 weeks and grade III sprains will keep athletes out for an average of 5 weeks. Each athlete is different with progression and if progression is slow, re-evaluation for other injuries is necessary.
MCL TEAR
What is it?
The menisci are two oval shaped pieces of cartilage that sit in the knee joint and cushion any stress placed on the joint. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other. The "Medial Meniscus" sits on the inside of the knee and the "Lateral Meniscus" sits on the outside. The medial meniscus is C-shaped and the lateral meniscus is an O-shape. The outer 1/3 of the menisci have a good blood supply, but as you go to the inside, the blood supply becomes less. Depending on the mechanism of injury, the type and placement of the tear will be different.
It hurts where?
If you tear your meniscus, your pain will be in the area of the tear. It will be along of the knee joint line, which is where the femur and the tibia come together. The tear can be in the front of the knee, the back or even the sides but it is always located at the joint line.
How does it happen?
A meniscus tear may be caused by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament) or MCL (medial collateral ligament). A meniscal tear is usually a non-contact injury.
Injury Progression
A meniscal tear will usually present with a pocket of swelling directly where the tear occurred. If you continue to play without treatment, the entire knee joint may swell or a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock-your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it to unlock. At this point, surgery is the most likely option to get you back to play.
Similar injuries
Meniscal tears can be confused with a few different things. One is a gastrocnemius tear at its origin at the back of the knee. Another is a hamstring tendon strain also at the back of the knee where the hamstring tendons cross right before they attach below the knee joint. Ligament tears may also be confused with a meniscal tear or may be associated with one. It is not uncommon to tear the medial meniscus when you tear your MCL or ACL or even both.
Treatment
The treatment of a meniscal tear will begin with ice, electric stimulation and rest. A visit to the orthopedist usually happens next with an MRI being prescribed. If there is a tear, it will show up on the films, in most cases. If the tear cannot heal on its own, surgery may be the best option. Rehabilitation exercises will help strengthen the musculature and help stabilize the knee. A very small percentage of meniscal injuries can be treated through rehab and without surgery for athletes. Occasionally, an athlete can postpone the surgery until the season is completed, depending on the severity of the tear.
Participation Status
Most people cannot participate at the varsity athletic level with a meniscal tear. Some people are able to if the tear is small and there is little swelling associate with it. Many people experience a popping, clicking and/or locking sensation that is painful or too irritating to continue to play. Once the tear has been fixed or removed it will take 3-6 weeks of rehab to get back into play, it is not necessarily a "season ending injury."
