Medial collateral ligament (MCL) injury of the knee?

Answer 1

Definition

An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) in the knee. A tear may be partial or complete.

Alternative Names

Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL)

Considerations

The knee is similar to a hinge joint, located where the end of the thigh bone (femur) meets the top of the shin bone (tibia). Four main ligaments connect these two bones:

• Medial collateral ligament (MCL) -- runs along the inner part (side) of the knee and prevents the knee from bending inward.
• Lateral collateral ligament (LCL) -- runs along the outer part (side) of the knee and prevents the knee from bending outward.
• Anterior cruciate ligament (ACL) -- lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.
• Posterior cruciate ligament (PCL) -- works with the ACL. It prevents the tibia from sliding backwards under the femur.

The ACL and PCL cross each other inside the knee, forming an "X." This is why they are called the "cruciate" (cross-like) ligaments.

ACL injuries often occur with other injuries. The classic example is when the ACL is torn at the same time as both the MCL and medial meniscus (one of the shock-absorbing cartilages in the knee). This type of injury often occurs in football players and skiers.

Women are more likely to have an ACL tear than men. The cause for this is not completely understood, but it may be due to differences in anatomy and muscle function.

Adults usually tear their ACL in the middle of the ligament or pull the ligament off the femur bone. These injuries do not heal by themselves. Children are more likely to pull off their ACL with a piece of bone still attached. These injuries may heal on their own, or they may require an operation to fix the bone.

When your doctor suspects an ACL tear, an MRI may help confirm the diagnosis. This test may also help evaluate other knee injuries, such as to the other ligaments or cartilage.

Some people are able to live and function normally with a torn ACL. However, most people complain that their knee is unstable and may "give out" with physical activity. Unrepaired ACL tears may also lead to early arthritis in the affected knee.

Causes

ACL tears may be due to contact or noncontact injuries. A blow to the side of the knee, which can occur during a football tackle, may result in an ACL tear.

Coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint (called hyperextended knee), also can cause injury to the ACL.

Basketball, football, soccer, and skiing are common causes of ACL tears.

Symptoms

Early symptoms:

• A "popping" sound at the time of injury
• Knee swellingwithin 6 hours of injury
• Pain, especially when you try to put weight on the injured leg

Those who have only a mild injury may notice that the knee feels unstable or seems to "give way" when using it.

First Aid

An ACL injury should be treated with:

• Elevating the joint (above the level of the heart)
• Ice
• Pain relievers such as nonsteroidal anti-inflammatory drugs (like ibuprofen)

Do NOT play again until you have been evaluated and treated.

Some people may need crutches to walk until the swelling and pain have improved. For mild injuries, your doctor may suggest physical therapy to help you regain joint motion and leg strength.

Your doctor may recommend surgery to rebuild the ACL. The old ligament cannot be fixed, so a new one needs to be constructed.

Do Not

• In the case of a serious knee injury, do NOT try to move the joint. Use a splint to keep the knee straight until a trained medical professional has evaluated it.
• Do NOT return to play until you have been evaluated and treated.

Call immediately for emergency medical assistance if

Anyone with a serious knee injury should seek medical attention for x-rays and evaluation.

If the foot is cool and blue after a knee injury, the knee may be dislocated, and blood vessels to the foot may be injured. This is a true medical emergency that requires immediate professional help.

Prevention

Use proper techniques when playing sports or exercising. Several women's College Sports programs have reduced ACL tears through a training program that teaches athletes how to minimize the stress they place on their ACL.

Although the issue is controversial, the use of knee braces during aggressive athletic activity (such as football) has not been shown to decrease the incidence of knee injuries and may give the player a false sense of security.

References

Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394-412.

Birmingham TB, Bryant DM, Giffin JR, Litchfield RB, Kramer JF, Donner A, Fowler PJ. A randomized controlled trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction. Am J Sports Med. 2008;36:648-655.

Answer 2

Definition

Medial collateral ligament (MCL) injury is a stretch, partial tear, or complete tear of the ligament on the inside of the knee.

Alternative Names

Knee injury - medial collateral ligament (MCL); MCL injury

Considerations

The medial collateral ligament (MCL) extends from the upper-inside surface of the shin bone to the bottom-inside surface of the thigh bone. The ligament stabilizes the joint on the inside of the knee.

Causes

The MCL is usually injured by pressure placed on the knee joint from the outside.

It is often injured at the same time as an anterior cruciate ligament (ACL) injury.

Symptoms

• Knee instability
• Knee pain and tenderness along the inside of the joint
• Knee swelling

First Aid

The health care provider will examine your knee. An MCL test will be done to detect looseness of the ligament. This test involves bending the knee to 25 degrees and putting pressure on the outside surface of the knee.

Other tests may include:

• Knee MRI
• Knee joint x-rays

Treatment includes applying ice to the area, raising the knee above heart level, and nonsteroidal anti-inflammatory drugs (NSAIDS). You should limit physical activity until the pain and swelling go away.

After an initial period of keeping the knee still (usually with a knee brace), knee strengthening and stretching exercises should be done. Physical therapy may be helpful to help regain knee and leg strength.

Surgery is not usually used for isolated tears of the MCL.

Call immediately for emergency medical assistance if

Call your health care provider if symptoms of MCL injury occur.

Call your health care provider if you are being treated for MCL injury and you notice increased instability in your knee, if pain or swelling return after they initially subsided, or if your injury does not resolve with time.

Also call if you reinjure your knee.

Prevention

Use proper techniques when playing sports or exercising. Many cases are not preventable.

Answer 3

Definition

Lateral collateral ligament (LCL) injury is a stretch, partial tear, or complete tear of the ligament on the outside of the knee.

Alternative Names

LCL injury; Knee injury - lateral collateral ligament (LCL)

Considerations

The lateral collateral ligament (LCL) extends from the top outside surface of the fibula (the bone on the outside of the lower leg) to the bottom outside surface of the thigh bone. The ligament holds the knee on the outside of the joint.

Causes

The LCL is usually injured by pressure placed on the knee joint from the inside, which results in stress on the outside of the joint.

Symptoms

• Knee instability
• Knee pain or tenderness along the outside of the knee
• Knee swelling

First Aid

A lateral collateral ligament test may reveal looseness in the ligament. This involves bending the knee to 25 degrees and placing pressure on the inside surface of the knee.

Other tests may include:

• Knee MRI
• Knee joint x-rays

Treatment includes applying ice to the area, raising the knee above heart level, and nonsteroidal anti-inflammatory drugs (NSAIDS). You should limit physical activity until the pain and swelling go away.

After an initial period of keeping the knee still (usually with a knee brace), knee strengthening and stretching exercises should be done. Physical therapy may be helpful to help regain knee and leg strength.

Surgery for isolated LCL injuries is not generally necessary. However, this ligament is commonly injured during significant trauma, including knee dislocations. When injuries to the LCL occur with other ligament injuries, surgical repair is needed to prevent future instability of the knee.

Call immediately for emergency medical assistance if

Call your health care provider if you injure your knee and symptoms of LCL injury occur.

Call your health care provider if you are being treated for an LCL injury and you notice increased instability in your knee, if pain or swellingreturn after they initially subsided, or if your injury does not go away with time.

Also call if you reinjure your knee.

Prevention

Use proper technique when exercising or playing sports. Many cases may not be preventable.

Answer 4

Definition

An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) in the knee. A tear may be partial or complete.

Alternative Names

Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL)

Considerations

The knee joint is located where the end of the thigh bone (femur) meets the top of the shin bone (tibia). Four main ligaments connect these two bones:

• Medial collateral ligament (MCL) runs along the inside of the knee and prevents the knee from bending out.
• Lateral collateral ligament (LCL) runs along the outside of the knee and prevents the knee from bending in.
• Anterior cruciate ligament (ACL) is in the middle of the knee. It prevents the shin bone from sliding out in front of the thigh bone.
• Posterior cruciate ligament (PCL) works with the ACL. It prevents the shin bone from sliding backwards under the femur.

Women are more likely to have an ACL tear than men.

Causes

An ACL injury can occur if you:

• Get hit very hard on the side of your knee, such as during a football tackle
• Overextend the knee joint
• Quickly stop moving and change direction while running, landing from a jump, or turning

Basketball, football, soccer, and skiing are common sports linked to ACL tears.

ACL injuries often occur with other injuries. For example, an ACL tear commonly occurs along with tears to the MCL and the shock-absorbing cartilage in the knee (lateral meniscus).

Most ACL tears are seen in the middle of the ligament, or the ligament is pulled off the thigh bone. These injuries form a gap between the torn edges, and do not heal on their own.

Symptoms

Early symptoms:

• A "popping" sound at the time of injury
• Knee swellingwithin 6 hours of injury
• Pain, especially when you try to put weight on the injured leg

Those who have only a mild injury may notice that the knee feels unstable or seems to "give way" when using it.

First Aid

See your health care provider if you think you have an ACL injury. Do not play sports or other activities until you have seen a doctor and been treated.

Your doctor may send you for an MRI of the knee. This can confirm the diagnosis. It may also show other knee injuries.

First aid for an ACL injury may include:

• Raising your leg above the level of the heart
• Putting ice on the knee
• Pain relievers such as nonsteroidal anti-inflammatory drugs (such as ibuprofen)

You may need:

• Crutches to walk untiol the swelling and pain get better
• Physical therapy to help improve joint motion and leg strength
• Surgery to rebuild the ACL

Some people can live and function normally with a torn ACL. However, most people complain that their knee is unstable and may "give out" with physical activity. Unrepaired ACL tears can lead to further knee damage.

Do Not

• Do NOT move your knee if you have had a serious injury.
• Use a splint to keep the knee straight until you see a doctor.
• Do NOT return to play or other activities until you have been treated.

Call immediately for emergency medical assistance if

Anyone with a serious knee injury should seek medical attention for x-rays and evaluation.

If the foot is cool and blue after a knee injury, the knee joint may be dislocated, and blood vessels to the foot may be injured. This is a medical emergency that requires immediate professional help.

Prevention

Use proper techniques when playing sports or exercising. Some college sports programs teach athletes how to reduce stress placed on the ACL.

The use of knee braces during aggressive athletic activity (such as football) is controversial, and has not been shown to reduce the number of knee injuries.

References

Griffin LY, Armstrong A, DeMaio M. The female athlete. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 10.

Honkamp NJ, Shen W, Okeke N, Ferretti M, Fu FH. Anterior cruciate ligament injuries: 1. Anterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 23, section D.

Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician. 2010 Oct 15;82(8):917-22.

Reviewed By

Review Date: 08/14/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 5

Definition

Medial collateral ligament (MCL) injury is an injury to the ligament on the inner part of the knee. This ligament keeps your shin bone (tibia) in place.

It can be a stretch, partial tear, or complete tear of the ligament.

Alternative Names

Knee injury - medial collateral ligament (MCL); MCL injury

Considerations

The medial collateral ligament (MCL) goes from the inside surface of the upper shin bone to the inner surface of the bottom thigh bone.

The ligament helps keep the inside portion of the knee joint stable.

Causes

The MCL is usually injured by pressure or stress on the outside part of the knee. A block to the outside part of the knee during football is a common way for this ligament to be injured.

It is often injured at the same time as an anterior cruciate ligament (ACL) injury occurs.

Symptoms

Symptoms of a tear in the medial collateral ligament are:

• Knee swelling
• Locking or catching of the knee with movement
• Pain and tenderness along the inside of the joint
• The knee gives way or feels like it is going to give way when it is active or stressed in a certain way

First Aid

The health care provider will examine your knee. An MCL test will be done to detect looseness of the ligament. This test involves bending the knee to 25 degrees and putting pressure on the outside surface of the knee.

Other tests may include:

• Knee joint x-rays
• Knee MRI

Treatment includes:

• Applying ice to the area
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
• Raising the knee above heart level

You should limit physical activity until the pain and swelling go away.

The health care provider may put you on crutches and in a brace to protect the ligament. You may also be told not to put any weight on your knee when you walk.

After a period of keeping the knee still, you will be taught exercises to strengthen and stretch the knee. Physical therapy may help you regain knee and leg strength.

Surgery is often not needed when only the MCL has been torn.

If you need surgery, it will be done using arthroscopy, through a small surgical cut.

Call immediately for emergency medical assistance if

Call your health care provider if:

• You have symptoms of MCL injury
• You are being treated for MCL injury and you notice increased instability in your knee, pain or swelling after they initially faded, or your injury does not get better with time
• You re-injure your knee

Prevention

Use proper techniques when playing sports or exercising. Many cases are not preventable.

References

De Carlo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010; 29:81-106.

Singhal M, Patel J, Johnson D. Medical ligament injuries: 1. Medical collateral ligament injuries in adults. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Dree's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 23;sect C.

Reviewed By

Review Date: 06/13/2010

Linda J. Vorvick, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 6

Definition

Lateral collateral ligament (LCL) injury is an injury to the ligament on the outer side of the knee.

It can be a stretch, partial tear, or complete tear of the ligament.

Alternative Names

LCL injury; Knee injury - lateral collateral ligament (LCL)

Considerations

The lateral collateral ligament (LCL) goes from the top part of the fibula (the bone on the outside of the lower leg) to the outside part of the lower thigh bone.

The ligament helps keep the outer side of the knee joint stable.

Causes

The LCL is usually injured by pressure or an injury that pushes the knee joint from the inside, which results in stress on the outside part of the joint.

Symptoms

Symptoms of a tear in the lateral collateral ligament are:

• Knee swelling
• Locking or catching of the knee with movement
• Pain or tenderness along the outside of the knee
• Knee gives way, or feels like it is going to give way, when it is active or stressed in a certain way

First Aid

A lateral collateral ligament test may reveal looseness in the ligament. This involves bending the knee to 25 degrees and placing pressure on the inside surface of the knee.

Other tests may include:

• Knee joint x-rays
• Knee MRI

Treatment includes:

• Applying ice to the area
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Raising the knee above heart level

You should limit physical activity until the pain and swelling go away. The doctor may put you on crutches and in a brace to protect the ligament. You may also be told not to put any weight on your knee when you walk.

After a period of keeping the knee still, you should do exercises to strengthen and stretch the knee. Physical therapy may help you regain knee and leg strength.

Surgery is often not needed when only the LCL has been torn. However, this ligament is often injured during significant trauma, including knee dislocations.

It is common for injuries to the LCL to occur with other ligament injuries. These are usually significant injuries, and you should seek medical help immediately. When injuries to other ligaments also occur, surgery is needed to prevent future instability of the knee.

Call immediately for emergency medical assistance if

Call your health care provider if:

• You injure your knee and have symptoms of LCL injury (injury to the LCL is often a serious knee injury, which can include many knee ligaments and injuries to the nerves and blood vessels)
• You are being treated for an LCL injury and you notice increased instability in your knee, pain or swelling return after they subsided, or your injury does not go away with time
• You re-injure your knee

Prevention

Use proper technique when exercising or playing sports. Many cases may not be preventable.

References

De Carlo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010;29:81-106.

Schorfhaar AJ, Mair JJ, Fetzer GB, Wolters BW, LaPrade RF. Knee: Lateral and postereolateral injuries of the knee. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 23;sect F.

Reviewed By

Review Date: 06/13/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.