The medial collateral Ligament (MCL) is a major stabilizing ligament of the knee. It is a thick band of tissue and is located at the medial (inside) knee, and connects your femur bone to your tibia bone. Athletes that perform cutting and jumping activities, as well as athletes that participate in contact sports, have higher rates of injury to this ligament. In football, wide receivers, running backs, and cornerbacks have higher rates of MCL injuries, but when tackled, any position on the football field may sustain an injury to this ligament.
Function of MCL:
The MCL’s main function is to limit the knee from going too far inward, as well as allowing the knee to rotate, without excessive motion. The general mechanism of injury is when an excessive amount of stress is placed on the ligament, causing it to tear. This can happen several ways:
An external force placed on the outside knee, pushing it inward. (ie. when a football player gets hit on the outside of the knee.)
Foot planted on the ground, with excessive rotation of the knee.
Landing from a jump with poor mechanics, and the knee “buckling” inwards
(Many MCL injuries that result from excessive force, involve damage to other structures in the knee, including the ACL and the meniscus)
Grades of MCL Sprains:
MCL sprains involve stretching, partially tearing or rupturing the ligament and are categorized into the following Grades:
Grade I: Fewer than 10% of fibers torn, mild tenderness, no swelling, no joint laxity
Grade II: Incomplete tear, 50-60% of fibers torn, significant tenderness, mild swelling, gapping at inside knee with stress test
Grade III: Complete tear of ligament, varying swelling, varying levels of pain, feeling of instability with weight bearing activities, gapping at inside knee with stress test.
Grade I&II MCL sprains are treated conservatively. Because of good blood supply to the ligament, physical therapy is the primary course of treatment. The goal is to reduce the swelling and pain, promote healing of the tissue, maximize strength and balance, and restore agility. Grade III MCL injuries may require surgery to reconstruct the ligament, depending on the site of injury. Recent treatment for Grade III tears is to treat conservatively, but if the tendon was avulsed (pull off bone), surgical intervention is usually required.
Time Frame for return to sport for a professional athlete
Grade I: 1-2 weeks
Grade II &III (non-surgical): 3-6 weeks (Determined by how well the athlete is healing).
Grade III: May take up to 8 weeks
Grade III (Surgical): 6 months
Initially, acute MCL tears will require bracing to assist with stability while walking. The brace will be weaned off as the athlete feels improved strength and stability. For grade II & III sprains, the doctor may opt to have the athlete wear a brace during play to protect the repair, as well as a preventative method against re-tearing the ligament. Each athlete must go through functional testing to determine when they can return to sport. For a wide receiver or running back in football, the player must be able to run, cut, and change directions without pain or instability.
NFL Players who had MCL injuries:
An MCL tear is very common in NFL football players, due to the high level of impact and stress the ligament endures. Below are examples of professional athletes and their time frames for return to play:
Andre Branch (DE)
Missed the first three games of the season after suffering a sprained MCL during the preseason Aug. 22, 2015 and returned October 4, 2015 (out 6 weeks)