Are you a sports fan? Maybe you play a sport like football, volleyball, or netball. Or maybe you run, jump, or lift weights. What if you suddenly feel a sharp pain on the inside of your knee with a 'click' sound? Or maybe you get hit by someone and your knee buckles inwards? At times like these, there is a high chance that your MCL, an important ligament in your knee, could be damaged. Today, we'll talk about what an MCL tear is, how it happens, and what to do about it.
Simply put, what is an MCL tear?
MCL stands for Medial Collateral Ligament . In Sinhala, it is a major ligament on the inside of the knee. Think of our knee as a joint. The upper bone (femur) and the lower bone (tibia) of this joint are connected, and the knee is stopped from moving to the side and kept stable by this strong band called the MCL. It is like a strong rope.
An MCL tear is when this strong ligament is damaged. The damage can be minor, or it can completely tear and separate into two pieces.
There are four main ligaments like this in our knees.
- Medial Collateral Ligament (MCL): The ligament on the inside of the knee.
- Lateral Collateral Ligament (LCL): The ligament on the back of the knee.
- Anterior Cruciate Ligament (ACL): The front of the two X-shaped ligaments inside the knee.
- Posterior Cruciate Ligament (PCL): The posterior one of the two X-shaped ligaments inside the knee.
Of these four, the MCL ligament is the most commonly injured.
How to Grade MCL Tears (Grades of Tears)
Your doctor will classify the severity of the tear. This is divided into three main stages (grades). Knowing this will help you understand your treatment.
| Grade | The nature of the tear | How you feel |
|---|---|---|
| Grade 1 (minor tear) | Less than 10% of the fibers in the bond have been torn. The bond is still strong. | There is a slight pain on the inside of the knee and tenderness when touched. The knee is stable. I can walk. |
| Grade 2 (moderate tear) | A significant portion of the ligament has torn, but not completely separated. | There is severe pain and tenderness on the inside of the knee. The knee may feel a little loose and unstable. It may be difficult to walk. |
| Grade 3 (severe tear) | The binding is completely torn and separated into two pieces. | There is severe pain. The knee is very unstable, feels like it is "jumping". It becomes almost impossible to stand with weight on it. Often, other ligaments, such as the ACL, are also damaged. |
What are the causes of an MCL tear?
The main cause of an MCL tear is a hard blow to the outside of the knee. Imagine you're playing football and someone tackles you and hits you on the outside of your knee, causing your knee to bend inward. This can cause the MCL ligament on the inside to tear.
In addition, MCL tears can also be caused by:
- Sudden change of direction: When one leg is placed on the ground and the body is quickly turned to the other side. This is common in sports such as basketball and netball.
- Landing incorrectly: Landing incorrectly when the knee bends and hits the ground.
- Hyperextension of the knee: This can happen in sports like skiing.
- Heavy lifting: When you lift something heavy with the wrong posture.
- Repetitive stress: When the knee is under stress for a long time, the MCL ligament can become weak and tear with even the slightest impact, like an old rubber band.
What are the symptoms of an MCL tear?
You may experience one or more of these symptoms in the event of an MCL tear.
- When the injury occurs , a 'clicking' or 'cracking' sound is heard from the inside of the knee .
- Pain on the inside of the knee.
- It hurts even when you touch the inside of your knee.
- Knee swelling and stiffness .
- Feeling like the knee will "jump" or "bend" when putting weight on the leg (instability).
- Feeling like your knee is stuck or locked when you bend or straighten it.
The most important thing is, if you can walk but still have pain or swelling in your knee, don't ignore it. Definitely see a doctor.
How do you find this, Doctor?
When you go to the doctor, he will first ask you about how the injury occurred. Then he will examine your knee.
- Physical Exam: The doctor will press the inside of your knee with his hand to find the exact location of the pain. Then, with your knee slightly bent, he will apply pressure from the outside to see how much the knee opens inward (valgus stress test). This will give you an idea of how loose the MCL ligament is.
- MRI Scan: This is the best test to confirm an MCL tear. An MRI can clearly show how much of the ligament is torn, as well as whether other parts, such as the ACL, are damaged.
- Ultrasound Scan: This can also check for things like a tear in the MCL ligament and fluid accumulation around it.
- X-ray: An MCL tear cannot be seen on an X-ray because X-rays only show the bone. However, your doctor may order an X-ray to rule out a fracture or other injury.
How is an MCL tear treated?
The good news for many people is that most MCL tears can be treated without surgery . Because the MCL ligament has a good blood supply, it is more likely to heal on its own.
Non-Surgical Treatment
- RICE method: This is the first and most important treatment.
- R - Rest: Give your knee a rest. Avoid running, jumping, or other activities that put pressure on your knee.
- I - Ice: Apply ice to the area of pain and swelling for 15-20 minutes several times a day. Do not apply ice directly to the skin, wrap it in a cloth.
- C - Compression: Wrap the knee with an elastic bandage to control swelling. Do not wrap it too tightly.
- E - Elevation: Keep your leg elevated as much as possible. This will reduce swelling.
- Painkillers: You can take NSAIDs (Non-steroidal anti-inflammatory drugs) to reduce swelling and pain, as advised by your doctor.
- Knee Brace: Your doctor may recommend wearing a special brace to stop your knee from bending to the side and to provide the stability needed for the MCL ligament to heal.
- Crutches: To reduce the weight on the knee, you may need to use crutches for a while.
- Physical Therapy: This is very important . As soon as the MCL heals, you should begin exercises under the guidance of a physical therapist. This will help you regain range of motion in your knee, strengthen your thigh and surrounding muscles, and return to normal activities.
Surgery
Surgery is rarely necessary.
- If the MCL ligament is completely torn (Grade 3), it appears to have detached from the bone.
- If another ligament, such as the ACL, is severely damaged along with the MCL tear.
- If you are a professional athlete and need maximum knee stability in the future.
Surgery involves sewing the torn ligament back together or reconstructing the ligament using a tissue graft taken from another part of the body (e.g., the hamstring tendon).
How long will it take to heal?
The healing time depends on the severity of the tear and how well you comply with treatment.
- Grade 1: Usually heals within 1-3 weeks.
- Grade 2: Can last about 4-6 weeks.
- Grade 3: Can take more than 6 weeks, possibly several months. If surgery is performed, it can take even longer.
The most important thing is not to rush, but to rest and exercise for the prescribed period as advised by the doctor and physical therapist. If you rush, there is a greater chance of the injury recurring.
Questions to ask the doctor
If you have an MCL tear, it's a good idea to ask your doctor questions like these.
- What type (grade) of MCL tear do I have?
- What treatment options do I have? Do I need surgery?
- How long do you think it will take to fully recover?
- What medicine should I take?
- Should I see a specialist?
- When should I start physical therapy?
- When will I be able to start playing again?
Take-Home Message
- An MCL tear is an injury to the ligament on the inside of the knee. It is a common injury among athletes.
- The main symptoms are pain, swelling, and instability of the knee.
- Most MCL tears can be treated without surgery with rest, ice, a brace, and physical therapy.
- Physical therapy exercises are very important in recovery. Don't skip them.
- If you have a knee injury, even if you can walk, do not ignore it and seek medical advice immediately. If the injury is severe, go to the Emergency Department (ETU) of the nearest hospital.
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