The medial collateral ligament (MCL) is a wide, thick band of tissue that runs down the inner part of the knee from the thighbone (femur) to a point on the shinbone (tibia) about 4 to 6 inches from the knee.

The unhappy triad is a major injury that can happen to a knee. It usually happens in contact sports or even motor vehicle accidents.

Let me just demonstrate this on this knee model here. So this knee model here, this is the front of the kneecap. This is the outside of the knee, as well – this is the inside of the knee. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option.  

With the unhappy triad there’s usually a force that happens right through here and can rupture the medial collateral ligament as well as the medial and lateral meniscus as well as the anterior crucial ligament, which all stabilizes the knee joint here.

Some of the symptoms that you may feel with the unhappy triad include – you may hear a pop when the injury occurred. There could be lots of pain and swelling, maybe difficulty to straighten or bending your leg. Your knee might feel quite unstable.

With the torn meniscus you might feel the catching or locking of the knee as you’re walking, may be harder to put weight onto your knee or walking just as you’re getting up from the injury.

Some of the treatment methods usually – most likely because it could be a fairly severe injury it’s usually a surgical intervention of possibly the ACL and the meniscus. Usually the MCL is – not operative treatment is preferred.

If it is not or even if it’s after the surgery you will still have to go through a rehabilitation process as well as physical therapy. Some of the things that we focus on with physical therapy is to control the pain and the swelling immediately and also try to regain your range of motion and allow proper tissue healing so you can get back to your work or sport as fast as possible.

One of the things that we do is to prescribe you a knee brace that will be helpful for you to get to back to activities of daily living, also help you go through your rehabilitation with increasing strength, increasing range of motion, and also increasing function so you get back to your everyday activity as soon as you can.

So if you suspect that you have a knee injury that could be an unhappy triad please consult your physician or physiotherapist to get a proper diagnosis so you can get back to work or play, however you can as soon as you can.    Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.  

Presenter: Mr. Lieon Kit, Physiotherapist, Vancouver, BC

Now Health Network  Local Practitioners: Physiotherapist

The MRI is the best way to look at disc herniations and to see the effect of the herniation on the nerve roots. We can see disc herniations with CT as well but we can’t identify the exact relationship to the nerve roots, or to the spinal cord higher up in the spine.

So there is much greater detail with MRI. This is an example of a lumbar spine MRI on an ahtlete who plays hockey and there are the normal disc spaces within the spine.

At this level the disc space is lost and we can see disc material extending into the spinal canal. This is a very large disc herniation that is pressing on the nerve roots within the spinal canal. The CT scan demonstrates the bones nicely and is very helpful if we’re concerned of a spine fracture.

What we don’t see as well on CT are the soft tissues, particularly in the lower lumbar spine there can be quite a bit of artifact and the detail within the disc herniation is not as well seen.

In particular we don’t see the impingement or compression of the nerve roots with CT, nor do we see the spinal cord with CT, so MRI gives us much better resolution.

The other benefit of MRI, we can view the anatomy in multiple planes. This is an axial image of the same area the disc herniation can be seen here. It’s a very large disc herniation. What MRI can do for us is identify the nerve roots which are not seen specifically with CT. We can identify the degree of compression of the nerve roots.

The detail shown with MRI helps the surgeon decide whether surgery is needed for disc herniation or just if conservative management is sufficient. If you have any questions about lumbar spine MRI contact your family doctor or an imaging center. Local Physiotherapist. 

Presenter: Dr. Audrey Spielmann, Radiologist, Vancouver, BC

Now Health Network Local Practitioners: Radiologist

MCL stands for media collateral ligament, and this is a ligament that spans the inside aspect of the knee joint and it stabilizes the knee from side-to-side translation.

The MCL is one of the most commonly injured ligaments in hockey, and actually in most sports. Particularly in sports that require a valgas loading of the knee, that is a loading of the knee from the outer aspect of the knee, so a direct blow to the lateral aspect - the outer thigh or the leg - can result in a tear of the medial collateral ligament.

An athlete who suffers an MCL tear will typically present with pain on the medial aspect of the knee, associated swelling, they may have difficulty weight bearing and they may even feel a sensation of popping in the knee.

Oftentimes, the timing and onset of swelling as well as the abilty to weight bear immediately after the event are particuarly important in understanding the extent of the injury.

It is really important that someone who faces this injury be seen by their primary care physician or preferably by a primary care sport medicine physician, not only to treat the problem at hand but also to make sure that there are no associated injuries such as injuries to the meniscus or the anterior cruciate ligament.

The MCL is a very vascularized structure and actually heals very well, so conservative treatment is the treatment of choice. This includes a visit to your primary care sport medicine physician as well as to your physiotherapist.

Early range of motion exercises in a protective fashion using a brace – a hinged brace - will lead to the best outcomes long term, and it has been noted that braces can be used for prevention as well in this condition.

Range of motion exercises as well as strengthening will allow the athlete to return to play. If you have any further questions regarding MCL tears please consult your local family physician or primary care sports medicine physician.

Presenter: Dr. Larissa Roux, Sports Medicine Physician, Vancouver, BC

Local Practitioners: Sports Medicine Physician