Investigations

The diagnosis of the MCL injury is entirely clinical, but with plain AP and lateral X-ray views we can rule out fractures, avulsion-fractures and in young individuals physeal injuries.



In some special situations comparative stress X-rays can be helpful to make the diagnosis.




The MRI can help us to determine the status of the MCL, posteromedial structures, cruciate ligaments and meniscus









Treatment

There are two principles in the treatment of the MCL injuries

• Protection of the MCL from further damage during the early healing phases, we accomplish this with a splint, and
  
  
• Early mobilization, this has been proved to promote and accelerate the healing process
  
  

The treatment of the acute injury partial or complete is the same, it consists of rest (crutches & immobilization), cryotherapy, elevation, compression, and NSAIDs. In the partial tears, after the first 48h when the swelling and the pain's gone down the patient can take off the splint and start the physiotherapy program. The physiotherapy program is aimed to decrease swelling and pain, increase the range of motion and strengthen the muscles around the knee.





In the complete tears basically the approach is the same but the patient must use the splint for six weeks, it's only removed during the physiotherapy.

If the swelling or pain doesn't decrease with the physiotherapy we have to re-examine the patient looking for additional injuries such as ACL or meniscal tears.

Actually most of the isolated MCL injuries are treated conservatively with good documented results, the worst results are found in the patients with a concomitant ACL injury. Some surgeons indicate the operative treatment of the avulsion-fractures or the complete tears involving the posteromedial structures.

The patient can return to athletic activities when he/she has full ROM, no pain or tenderness, no instability and 85-90% muscle strength compared with the normal side.










References

Cyril B.F. Ligament healing: Current knowledge and clinical applications. J.A.A.O.S. 4(2), 1996:74-83


Reider B., Sathy M.R., Talkington J. Treatment of isolated medial collateral ligament injuries in atheletes with early functional rehabilitation. A five-year follow-up study. J.A.O.S.S.M. 22(4), 1994: 470-477


Fu F.H., Harner C.D., Jahnson D.L., Miller M.D., Woo S.L. Biomechanics of knee ligaments. Basic concepts and clinical application. J.B.J.S. 75-A (11), 1993: 1716-1727


Noyes F.R., Barber-Westin S.D. The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 23(4), 1995: 380-389


Lungberg M., Messner K. Decrease in valgus stiffness after medial knee ligament injury. A 4-year clinical and mechanical follow-up study in 38 patients. Acta Orthop Scand 65(6), 1994: 615-619


Derscheid G.L. Garrick J.G. Medial collateral ligament injuries in football: Non operative management of grade I and grade II sprains. Am J Sports Med 9, 1981: 365-368


Indelicato P. Hermansdorfer J. Huegel M. Non operative management of complete tears of the medial collateral ligament of the knee in intercollegiate football players. Clin Orthop 256, 1990: 174-177