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What’s Up Doc column: MCL injuries are very common

Dr. Jeff Hersh
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The Rolla Daily News

Columns share an author’s personal perspective.

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Q: I tweaked my knee hiking and it hurts by the inside area and I am limping now. Thoughts?

A: There are many possible causes, and you should see your health care provider to be evaluated. One possible cause is an injury to the medial collateral ligament (MCL), and that will be today’s focus.

MCL injuries are very common. It is not known just how common since many never come to a medical provider’s attention, but over a third of knee injuries that are evaluated in a health care setting include an MCL injury, making it the most common overall knee injury. It can affect anyone of any age group.

The knee is a hinge joint, designed to be able to go from straight to fully bent where the calf presses up against the thigh. It is not designed to bend sideways (unlike other joints such as the shoulder, wrist and hip, which have a lot more degrees of motion possible). The MCL is a multilayered ligament on the inside part of the knee (the side that faces the other leg) that helps stabilize the knee, specifically from bending outwards (away from the other leg).

MCL injuries may occur from direct contact injuries (most commonly when the patient is struck on the outside of the knee), twists/torque and even overuse.

Other knee structures, especially in more severe MCL injuries, may be involved. For example, a quarter to three-quarters of MCL injuries (depending on the severity of the MCL injury) also affect the anterior cruciate ligament (ACL), the meniscus is involved in up to a quarter of cases and other structures, including broken bones, may occur as well.

Injury to the MCL may be evident on physical exam when the knee is examined and excessive movement, usually with reproduction of pain, is identified when the examiner gently tries to bend the knee outward. As other knee structures could be affected, X-rays - to look at bones - and an MRI - to look at other structures - may be indicated.

There are different “grading” systems that assess the severity of an MCL injury on a scale from 1 to 3:

• Grade 1 (mildest): few torn fibers as evidenced by small amounts of excess movement/joint opening (0 to 5 mm) as the joint is attempted to be bent outwardly.

• Grade 2: partial, but incomplete, tear, as evidenced by a medium amount of excess movement/joint opening (5 to 10 mm).

• Grade 3: complete tear as evidenced by large, pathologic laxity (looseness) allowing large joint opening (over 10 mm).

The goal of treatment for an MCL injury is to help the patient regain range of motion (ROM), strength and functionality while minimizing pain. Most MCL injuries resolve without the need for surgery, although the more severe the injury the longer the healing time required.

The initial treatment is RICE (rest, ice, compression and elevation) to minimize swelling. Your clinician may advise limited weight-bearing by using crutches, a knee brace (often a hinged brace) or other immobilization techniques. The duration needed for these initial treatments may be a couple of days for a minor injury with return to sports in a couple of weeks and full resolution in a few months, to longer resting and no return to sports for a couple of months and full resolution in many months to a year. Some select patients with severe MCL injuries or with injuries involving other knee structures may require surgery.

The treatment duration required, including holding off on returning to sports activities, is dependent on how long it takes for strength, range-of-movement and full functionality to return. The good news is that, overall, MCL injuries have a good prognosis and most patients recover fully.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.