Richard Stockton College Athletic Training
Common Athletic Injuries
 Following is some information on injuries that athletes frequently encounter.
It is brief and to the point, not a detailed medical analysis of an injury.  Therefore use
the information accordingly.

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Fast Facts:

Adductor Tubercle just above the medial femoral condyle and the insertion of the adductor muscles.

Medial Joint Line= junction of femur and the tibia at the knee on the inside.

Tibial External Rotation occurs when the lower leg/ foot are rotated outward.

PCL= Posterior Cruciate Ligament.
Medial Collateral Ligament
(MCL) Sprain

By Brian Corbett. Brian is a senior Athletic Training Student at Salisbury University. He completed his senior internship at Stockton.

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.

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. 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.
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