Medial Collateral Ligament Injury Sports. MDMedial collateral ligament injuries to the knee are not uncommon. Many well recognized professional athletes, including Jay Cutler, Hines Ward, Knowshan Moreno, and Troy Polamalu, have suffered from a medial collateral ligament tears after injury on the football field. These can occur alone or in combination with other ligament or cartilage injuries of the knee in athletes. What is the medial collateral ligament The Medial Collateral Ligament MCL, together with the cruciates and lateral collateral ligament, is critical to the stability of the knee joint. The MCL is a fibrous band of tissue made up of collagen fibers that runs along the inner aspect of the knee from the end of the thigh bone femur to the top of the shin bone tibia. In this location, the MCL provides side to side stability to the knee and prevents widening of the inner aspect of the joint with forces applied to the outside of aspect of the knee valgus force. When significant forces are applied to the outside aspect of the knee, as can occur during a tackle in football or awkward slide into base with baseball, the ligament can be stretched sprained or torn. The MCL is made up of a superficial and a deep layer. The superficial MCL runs from the distal femur to the tibia 4 or 5 centimeters below the knee joint line, and is found just below the sheath of the sartorius muscle tendon. The deeper MCL layer lies just outside of the knee capsule and inserts directly into the tibial plateau and medial meniscus. The superficial layers is much more mechanically important in resisting forces to the outside aspect of the knee valgus force. Dr. Brian Cole is an orthopedic specialist in Midwest Orthopedics who provides shoulder, knee and elbow surgery for patients in Chicago. Introduction The medial collateral ligament is both a primary and secondary valgus stabilizer of the knee. Ulnar collateral ligament UCL injuries occur when repetitive stress damages the inside of the elbow. How is the MCL injured in athletes Because the MCL resists widening of the inside of the knee joint, the MCL is usually injured indirectly by traumatic forces in the outside of the knee. These are certainly common in contact sports from tackles or clipping injuries in football and soccer. However, MCL injuries can also occur from noncontact mechanisms such as awkward landing or pivoting events in basketball or slides into base with baseball. An MCL tear or sprain can occur in isolation or in combination with injury to the meniscus, cartilage, or cruciate ligaments. Ulnar Collateral Ligament Elbow Physical Therapy' title='Ulnar Collateral Ligament Elbow Physical Therapy' />Medial collateral ligament symptoms. The most common symptom following a MCL injury is pain directly over the medial aspect of the knee. The MCL can be tender to palpation over its attachment to the thighbone femur proximally, at its mid substance, or distally over the shin bone tibia depending on the location of injury. The pain may also be reproduced by stressing the knee with a force applied to the outside aspect of the knee valgus force, attempting to widen the inner aspect of the joint and stress the MCL. While a valgus force is applied, the inner aspect of the joint line can be palpated widening that is 5 to 1. MCL injury. Swelling over the torn ligament may appear, and bruising or general swelling of the joint is not uncommon. In more severe injuries, patients may complain that the knee is unstable and feel as though their knee may give out or buckle. Ulnar Collateral Ligament Elbow Physical Therapy' title='Ulnar Collateral Ligament Elbow Physical Therapy' />The ulnar collateral ligament UCL of the elbow is critical for valgus stability of the elbow and is the primary elbow stabilizer. As such, the UCL plays. The elbow includes prominent landmarks such as the olecranon the bony prominence at the very tip of the elbow, the elbow pit, the lateral and medial epicondyles. Introduction Attenuation or rupture of the ulnar collateral ligament of the elbow leads to valgus instability Epidemiology. Physical Therapy in Corpus Christi for Wrist Issues. Welcome to Humpal Physical Therapy Sports Medicine Centers resource to Triangular Fibrocartilage Complex TFCC. Based on physical examination, MCL injuries are graded in severity on a scale of I to III. Grade I injuries are incomplete tears of the MCL. The ligament is still intact but stretched, and the symptoms are mild. Patients usually complain of pain with palpation of the MCL. A grade II MCL tear is a partial or incomplete tear. There is significant pain with valgus stress of the knee and palpation along the medial aspect on the knee over the ligament. Athletes with these tears often complain of knee pain or instability when attempting to cut or pivot. Grade III tears are complete tears of the MCL. These athletes have significant pain along the medial aspect of the knee. Even deep bending of the knee is uncomfortable. These tears often occur in combination with other injuries in the knee, and complaints of giving out or instability with walking, running, or pivoting is common. A knee brace or a knee immobilizer is usually needed for comfort. What is the role for imaging studies with an MCL tear in athletes Plain radiographs can sometimes be helpful with MCL injuries. When the ligament has torn off the thigh bone femoral side, it often tears with a piece of bone that is visible on x ray. With old or recurrent injuries to the femoral side of the MCL, calcification at its origin can develop this has been termed the Pellegrieni Stieda lesion. Under most circumstances, however, plain radiographs are most helpful in ruling out associated fractures with MCL injury. MRI is the imaging study of choice to diagnose MCL tears. Injuries are readily identified on a T2 sequence that shows loss of continuity of the ligament and surrounding blood and fluid from the injury. The MRI will also localize the injury to the ligament to be proximal at the femur, in its mid substance, or distally at the tibia. Medial collateral ligament treatment. Medial collateral ligament treatment for an athlete rarely requires surgical intervention. Usually rest and anti inflammatory medications followed by rehabilitation will allow patients to resume their previous level of activity. All MCL injuries, however, are not created equal. Therefore, the time for an athlete to return to play is highly variable and dependent on the severity of the injury. Grade I injuries usually resolve without complication. They are typically managed with rest, ice, and nonsteroidal anti inflammatory medications until the knee is pain free to examination or routine activities. Most athletes with a grade I MCL tear will be able to return to their sport within 1 2 weeks following their injury. When a grade II MCL tear occurs, a hinged knee brace is commonly used to protect the knee from valgus forces. Nonoperative treatment also ensues with icing, nonsteroidal medications, and controlled rehabilitation. Athletes with a grade II injury can return to activity once they are not having pain to palpation or stressing of the MCL with a valgus force. Athletes can often return to sports within 3 4 weeks after their injury, but may remain in a protective hinged brace with contact sports. When a grade III injury occurs, the pain usually significant in the acute post injury period. Athletes usually require a hinged brace locked in extension and crutches to protect against weightbearing for 1 to 2 weeks. As the pain resolves, the brace can be unlocked to allow range of motion as tolerated. Gradual weightbearing can be initiated as well. Once the athlete can comfortably flex the knee to 1. Light running can begin once the athlete has regained their quadriceps strength compared to the opposite side, and sporting activity can follow as long as the athlete remains pain free. Complete rehabilitation from a grade III MCL tear can range from 6 weeks to 4 months. More Information Read about sports injury treatment using the P. R. I. C. E. principle Protection, Rest, Icing, Compression, Elevation. Medial collateral ligament surgery. Most medial collateral ligament tears of the knee do not require surgery and will heal with time and rehabilitation. Sdr Radio Software. However, some severe Grade III MCL tears will not heal and residual instability with opening of the joint to stress on the outside aspect of the joint valgus force can persist. These type of MCL injuries are frequently seen in combination with associated ACL tears or high energy, knee dislocation injuries.