MCL and LCL Injuries
A Personal Approach
What is it?
The MCL (Medial Collateral Ligament) is a dense band of fibrous connective tissues that are on the inside of the knee and act as a stabiliser connecting your femur to the tibia. There is a deep and superficial part to the MCL. It helps give stability with sideways movements when walking, running and bending. The equivalent on the outside of the knee is the LCL ( Lateral Collateral Ligament) that runs from the femur to the fibula. Together with the popliteofibular ligament, the capsule of the joint and the popliteus tendon, the LCL forms the PLC Complex which provides external rotational stability. Collectively the MCL and LCL can be called the collateral ligaments.
MCL or LCL Tear, How does it occur?
An MCL injury or tear is usually caused by your knee being stressed on the inside. This is normally from a force on the outside pushing your knee towards the other one. This may occur if you have had an impact on the outside such as a direct blow in rugby or a tackle in football. You can also injure your MCL through twisting your knee or a fall such as in skiing or turning quickly. The stress placed on the medial or inner aspect of the knee then causes trauma to the MCL and can sometimes cause a tear. An LCL injury is very similar in mechanism but the stress has been placed on the inside causing a high load on the outside. This basically pushes the knee outward stressing the ligament. Also, a turn, or twist may also contribute to an LCL injury. Many times an MCL or LCL injury is also combined with other injuries. If we injure the MCL we may also cause trauma to the joint capsule, the Medial meniscus or others. The LCL can also be injured with what we call the PLC (Posterior Lateral Corner) this also involves the popliteofibular ligament, the popliteus tendon, the biceps femoris tendon, the iliotobial band and other.
What to do if you think you have injured your MCL or LCL?
If you believe you have injured your MCL or LCL no matter how small, you should still keep weight off your leg to protect from further trauma. Ice the knee to help swelling and pain and seek assistance from your physiotherapy or Doctor as soon as possible. If your knee feels unstable try and avoid any walking or loading until you have seen your Health Professional.
Treatment- Conservative Treatment
If you have a torn MCL or LCL the treatment options are based on the severity of your tear. For grade I injuries, full activity may be gained in 3 to 4 weeks. For grade II injuries, full activity may be acquired in 6 to 12 weeks and a Grade III injury if treated no operatively may be suitable for activity return in 3-6 months. However, a grade III is also treated through surgery if deemed the most suitbale outcome. On most occasions, MCL injures are treated conservatively. You may be given a Brace, Crutches or just advised to protect it and undergo a course of physiotherapy. However, it should be noted that early controlled and prescribed activity after injury, including repetitive loading, has profoundly beneficial effects on ligaments and tendons in comparison to immobilization. The LCL will follow a similar path however it does not heal as well as the MCL and the rehabilitation may slightly differ due to its connection with the PLC.
Your recovery will depend on the severity of the tear. Like all structures, the ligament will go through different phases of healing. From the initial Inflammatory phase to the proliferation, regenerative phase and then to the remodelling phase. Once this has occurred you will then be able to return to normal activities and sporting interests.
Surgery and Recovery
MCL surgery is undertaken by doing one of two procedures which are an MCL repair and reconstruction. This will depend on where the injury is and how severe it is. If it is torn from the bone attachment it may be attached by some anchors. However, if there is a tear in the middle it may be possible to repair it but if not a graft will be used and it will be reconstructed.
With an LCL acute or new tear then it may be reattached to the femur or the fibula or may be repaired if possible. However, in many cases, reconstruction is undertaken.
Recovery from your operation will be slow initially as you will be having to Offload and protect your ligament. Crutches are used and you will be in a brace for possibly 8 weeks. You will be having to Ice often, undergo your rehab and take medication as guided. Initially, you will have swelling and reduced movement and some pain. With an and MCL and LCL operation, you may be using crutches for the first 6 weeks then gradually increasing your activity and rehabilitation as suitable. Overall it may take 6 months or slightly longer to completely recover
As Stuart Mailer has extensive experience in MCL and LCL injuries and post-operative he can guide you safely back helping reduce your pain and progress you quickly and safely. This is done by a bespoke programme for your knee operation, discussions with your consultant and your lifestyle and goals.