Medial Collateral Ligament (MCL) Tear

Development of MCL Tear• A valgus force to the knee while bearing

weight can put enough stress on the MCL to tear it

• Since the deep part of the ligament is damaged first and this portion inserts into the medial meniscus, there can be concomitant injury here

Symptoms of MCL Tear• There are three grades with different symptoms and

severity• Grade 1 symptoms (stretched ligament)

– Mild Tenderness on the inside of the knee– No swelling need be present– Pain on Valgus stress test but no laxity

• Grade 2 symptoms (partial thickness tear of the ligament)– Significant pain in the medial aspect of the knee– Moderate swelling present– Valgus stress test will indicate moderate instability

• Grade 3 symptoms (full thickness tear, or complete tear)– Varied amounts of pain– Significant joint laxity on valgus stress test– Complaints of instability (“wobbly” or “unstable” complaints)– These injuries can also include tears to the ACL

Grades of Ligament Tears

Differential Diagnosis Tests• Valgus stress test• Palpation of the medial aspect of the

knee from medial femoral condyle to the medial tibial plateau

• Slocum’s modified anterior drawer test

• Anterior drawer test with external rotation

• These help differentiate from Pes Anserine Tendinopathy and Bursitis issues

Slocum’s Modified Anterior Drawer Test

Anterior Drawer Test with External Rotation

Recommendation• Time from injury, location, severity, and concomitant

injuries will indicate need for surgery or if conservative treatment will be sufficient

• Grade II injuries are treated initially with immobilization, R.I.C.E., and protected weight bearing– After swelling subsides then stretching, resistive

exercise, and progressive weight bearing can be initiated• Grade I can begin second phase of grade II

rehabilitation right away• Grade III tears require surgical intervention and

referral to a doctor

Prognosis• Isolated grade I and II MCL tears

respond well to conservative treatment and usually do not require surgical intervention–Most people in this group have no long

term disability related to their injury• Grade III tears will require surgery

for repair

References• Reider B. Medial collateral ligament injury in

athletes. Sports Med. February 1996;21(2): 147-156.

• Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. June 2006;14(2): 105-110.