What is a MCL Knee Injury

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.

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Lieon Kit, BScPT, IMS, Physiotherapist, discusses knee injury and explains what ‘the unhappy triad’ is.

Quiz: Do You Understand MCL (Medial Collateral Ligament) Knee Surgery?

Test your knowledge by answering the following questions:

Questions
True
False
1

Medial collateral ligament sprains range in degrees of severity from 1 to 5.

Explanation:
Medial collateral ligament sprains range in degrees of severity from 1 to 3, with 3 being the worst (a complete tear of the ligament). The majority of MCL injuries are grade 1 and 2, and are generally treated non-surgically.
2

These injuries are common in sports such as downhill skiing and hockey, as are ACL tears.

Explanation:
These injuries are common is sports such as downhill skiing and hockey, as are ACL tears. It occurs when there is a valgus load to the knee, which is when the force is coming from the outside and the ligament on the inside gets stretched or twisted.
3

Symptoms of a medial collateral ligament sprain include pain along the medial side of your knee, swelling and stiffness.

Explanation:
Symptoms of a medial collateral ligament sprain include pain along the medial side of your knee, swelling and stiffness. You should see your family doctor if these symptoms are more significant.
4

The best initial treatment for an MCL injury is usually surgery.

Explanation:
The best initial treatment is with the RICE protocol (rest, ice, compression and elevation) and anti-inflammatories. On average, it takes six weeks for an MCL injury to heal.
5

MCL reconstruction surgery is done arthroscopically.

Explanation:
MCL reconstruction surgery is rarely required, but if it is it’s typically done through a small incision on the inside of the knee. It cannot be done arthroscopically, as the medial collateral ligament is not inside the knee joint.
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Dr. Jordan Leith, MD, MHSc, FRCPC, Orthopedic Surgeon, discusses MCL (Medial Collateral Ligament) knee injuries.

Larissa Roux, MD FRCP Dip Sport Med, MPH, PhD, discusses MCL tears in hockey.

Behnad Honarbakhsh, MPT, BHK, CSCS, CAFCI, D.O.(c), discusses MCL injuries in skiing.

 

Knee Injury and the 'The Unhappy Triad' - Marpole Physiotherapy

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.

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.

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

Local Practitioners: Physiotherapist

MCL (Medial Collateral Ligament) knee injuries.

An MCL sprain is an injury to the medial collateral ligament of the knee. A sprain defines that it’s a ligament, and it’s a stretching injury to ligaments.

Looking on a model of the knee, again, we’ve got the kneecap, your thighbone, your shinbone. This is the medial side of the knee and the lateral side of the knee. The medial collateral ligament is this structure that runs along the medial side of the knee, and it stops the knee from opening medially.

So when you injure the medial collateral ligament, you stretch this ligament. It usually is injured from a blow to the lateral side of the knee that causes the stretch to the medial collateral ligament.

That’s what results in a medial collateral ligament sprain. There’s a number of degrees of sprains, from 1 to 3, 3 being the worst, which is a complete tear of that ligament.

The majority that we see are Grade 1 and 2, and they’re just a stretch and a little more significant stretch. They’re usually treated non-surgically. They rarely require surgery. If you do have a medial collateral ligament sprain, you will have pain along the medial side of your knee. You will have some swelling. You will have stiffness.

The best way to treat them initially is with ice and rest and anti-inflammatories. You should potentially see your family doctor if these symptoms are more significant.

Your family doctor may choose to refer you to a physiotherapist for treatment. If physiotherapy does not relieve your symptoms within the first six to eight weeks, then you may be best to be referred to a surgeon.

If you have any questions regarding an MCL injury or you think you have an MCL injury that you have further concerns about, then I would seek consultation with your family doctor.

Video Title: MCL (Medial Collateral Ligament) knee injuries.

Presenter: Dr. Jordan Leith, Orthopaedic Surgeon, Burnaby, BC

Local Practitioners: Orthopaedic Surgeon

MRI Scans for Knee Injuries and When They Are Important

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

Local Practitioners: Radiologist

Audrey Spielmann, MD FRCP(C), discusses MRI Scans for Knee Injuries and When They Are Important.

 

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