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.
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.
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
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.
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.