Knee MCL

The most common cause of this injury is a direct impact or blow to the lateral (outside) aspect of the knee causing a sudden gapping force on the inside of the knee. The medial collateral ligament can become strained, stretched or torn. A general rule of thumb is the greater the force, the more severe the ligament injury. The highest incidence of collateral ligament injuries is between 20-34 and 55-65 years of age, but they can occur at any age.

In response to this type of injury one should initiate the following:

• Rest to avoid aggravating the injured knee and ligament through excessive activity.
• Immobilization to keep the ligament from being stressed any further and to promote healing in the correct position. Depending on the severity of the injury the knee may be immobilized for a period of time.
• Ice to reduce inflammation and pain for the first 48-72 hours. Do not apply ice directly over the skin and only use ice intermittently during the day. Do not apply any form of heat during this period.
• Contact your physician or healthcare provider for complete diagnostic evaluation of the injury and follow up care.
• Physical therapy may be indicated to treat and rehabilitate this injury for Grade I-III injuries.

Initial treatment will focus on ligament protection, reducing pain and swelling, as well as restoring motion. As the physical therapy program progresses, strengthening, flexibility, and aerobic exercises, in addition to technique and proprioceptive training to protect the knee and ligament, will be added in and effort to restore a normal level of activity.

Grade I-II injuries may start off with immobilization to protect the ligament and joint. Physical therapy will be progressed based on the individual’s symptoms, with the removal of the immobilizing device, and the initiation of a stretching, strengthening, and functional rehabilitation program.

Grade III injuries will require immobilization for a longer period of time and progression of weight bearing with use of a hinged brace to protect the ligament. Physical therapy will focus on restoring motion and strength. Full return to activity will depend on:

• Restoration of pain free full range of motion
• Patient ambulating independently without a limp
• Objective quadriceps strength in the 90% range

Common physical therapy interventions for this condition include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the knee.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strength to protect and stabilize the knee and affected ligament.
• Neuromuscular Reeducation (NMR) to restore stability, begin retraining the lower extremity chain and improve movement technique and mechanics (running, jumping and cutting) in use of the involved knee in daily activities.
• Modalities that can include use of ultrasound, electrical stimulation, ultrasound, ice, cold laser and others to decrease pain and inflammation at the knee and ligament.
• Home program includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Following an injury to the medial collateral ligament one should seek a full evaluation from a physician or health care provider. Treatment may consist of the following;

• Clinical evaluation, including a physical exam, X-rays and MRI for more severe Grade III-IV injuries
• Use of ice and immobilization to stabilize and rest the joint
• Anti-inflammatory medication and pain medication, as needed
• Progression to a hinged brace if indicated
• Referral to physical therapy to progress rehabilitation following a period of immobilization.
• Surgery if indicated in Grade IV or cases involving damage to other knee structures (like the meniscus or ACL.)