Medial Collateral Ligament (MCL) Tear Symptoms and Treatment

A medial collateral ligament (MCL) tear affects the inside of the knee. The tough MCL ligament fibers that connect the end of the femur (thigh bone) and the top of the tibia (shin bone) can tear, causing instability of the knee joint. The MCL is one of four major knee ligaments, including the anterior cruciate ligament (ACL).

An MCL injury is commonly caused by a blow to the outside of the knee joint that pushes the knee inward toward the other one and causes it to buckle. This stretches the MCL and can cause tearing. An MCL injury can involve a partial or complete tear, or occur as part of a complex knee injury involving the meniscus or ACL. Usually, physical therapy and a knee brace can be used to treat the injury.

Symptoms

About 40% of all knee ligament injuries involve the MCL. Symptoms of MCL injury can include:

• Pain or tenderness along the inside of the knee (can be mild or severe)
• Swelling at the knee injury
• Stiffness when trying to move the knee
• A feeling that the injured knee may give way (buckle) or lock up
• A popping sound at the time of injury

Bruising is common one to two days after the injury. In more severe cases, the bruising may affect the bone.

Symptoms of an MCL injury tend to correlate with the extent of the injury. MCL injuries are usually graded on a scale:

• Grade 1 — Some tenderness and minor pain. Just a few fibers are affected and the ligament damage is mild. The knee joint remains stable.
• Grade 2 — An incomplete or partial tear with some looseness at the knee. Increased pain.
• Grade 3 — More severe symptoms with complete tear of the MCL.

A more severe tear increases the risk of damage to other adjacent knee structures.

Causes

Sports injuries are the most common reason for MCL injuries. Males who ski, for example, or who play ice hockey or football, may be at higher risk for MCL tear. They also can occur if you land on your knee wrong during a fall, or your foot gets caught and the leg motion causes a knee injury. The MCL tear or damage can follow a vehicle accident, too.

Lifting heavy objects or other motions that lead to repetitive stress also increase the risk of MCL injury. So can certain health conditions associated with knee problems, including:

• Obesity
• Osteoporosis
• Inflammatory arthritis
• Valgus knee deformity

Diagnosis

Your healthcare provider will complete an exam with a hands-on focus on how the knee moves and what symptoms you experience. They'll also ask questions about how the MCL injury occurred, since this can help to identify whether other knee structures are involved.

Imaging tests are needed to confirm a diagnosis and can include:

• X-rays
• Magnetic resonance imaging (MRI)

One MCL abnormality is called the Pellegrini-Stieda sign or syndrome. It is seen on an X-ray when calcium deposits affect the ligament as part of a chronic condition.

Treatment

Treatment of an MCL tear depends on the severity of the injury. You can expect:

• With Grade 1 injury, home treatment or the use of crutches may be needed for just a week or so. Rest, ice, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) usually resolve your MCL tear symptoms.
• With Grade 2 injury, symptoms may take about a month to improve. Along with home care and over-the-counter pain relief, you may need to use a knee brace and keep weight off the knee.
• With Grade 3 injury, you may need to keep weight off the knee for up to six weeks. It's common to wear a knee brace for a few months as the MCL injury heals.

Physical therapy may be recommended as part of your recovery. Rarely, surgery is required to repair the MCL tear but usually that happens when other knee structures, like the ACL, also are damaged.

Prevention

For people returning to sports, a healthcare provider may recommend wearing a brace. Other steps you can take to limit the risk of MCL tear include:

• Proper stretching before and after exercise
• Appropriate shoes or footwear to ensure cushioning and support
• Using a knee brace at work

Summary

The medial collateral ligament (MCL) tear is a common injury to the inside of the knee that typically occurs in certain sports. Severity of the MCL injury falls into one of three grades, depending on symptoms of pain or mobility problems as well as other affected parts of the knee.

Most people will recover from a MCL tear within a few weeks or months, typically using OTC pain relief, knee braces, ice, and resting the knee. Physical therapy and, in rare cases, surgery also may be needed. Keep in mind that some chronic MCL conditions also occur, so talk with your healthcare provider about any ongoing treatment or prevention needed.