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Introduction

Knee Pain

MCL Tear

A medial collateral ligament (MCL) tear is a common knee injury. It most often happens to people who play sports like football, basketball and skiing. MCL tears are most often treated without surgery, though there are surgery options.

The MCL is a major ligament that’s located on the inner side of your knee. The tear can be partial (some fibers in the ligament are torn) or complete (the ligament is torn into two pieces).

MCL tears can be classified into three grades:

  • Grade 1: A mild tear in which less than 10% of fibers in your ligament are torn and your knee is still stable. You’ll likely have some tenderness and mild pain if you have a grade 1 tear.

  • Grade 2: A moderate tear in which your MCL is partially torn — usually the superficial part of your MCL. Your knee will likely be loose when it’s moved by hand, and you’ll probably have intense pain and tenderness along the inner side of your knee.

  • Grade 3: A severe tear in which your MCL is completely torn — both the superficial and deep parts. Your knee will likely be very unstable and loose, and you’ll probably experience intense pain and tenderness. It’s common for someone to have other knee injuries, especially damage to their anterior cruciate ligament (ACL), if they have a grade 3 MCL tear.

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Causes

MCL tears most often happen when the knee is hit directly on its outer side. They may also happen due to a sudden and forceful turning, twisting or “cutting.” This stretches the ligaments on the inside of the knee too far or can tear them. People who play certain sports like football, rugby, basketball, skiing and volleyball are more prone to MCL tears.

 

The following things may cause an MCL tear:

  • Planting one foot into the ground and forcefully shifting direction (this is known as “cutting” in sports).

  • When something or someone hits your knee on its outer side, such as from a football tackle.

  • Squatting or lifting heavy objects.

  • Landing awkwardly on your knee after a jump.

  • Hyperextending (overstretching) your knee. This is common in skiing.

  • Repeated pressure and stress to your knee, which causes your MCL to lose its elasticity.

 

Athletes may suffer tears of the MCL and anterior cruciate ligament (ACL) at the same time.

Symptoms
  • Popping sound at time of injury

  • Pain ranging from mild to severe

  • Stiffness and swelling

  • Tenderness along the inside of the knee

  • Feeling that the knee may “give way” under stress

  • Feeling that the knee will lock or catch

Diagnosis

In most cases, a healthcare provider can tell if you have a torn MCL by doing a physical exam on your knee. If your provider thinks you may have an MCL tear, they'll bend your knee and apply pressure on it to see if your knee is loose. Your provider may have you undergo imaging tests to make sure you don’t have any other injuries in your knee and to see how severe your MCL tear is.

 

Your healthcare provider may use one or more of the following tests to diagnose an MCL tear:

  • Physical exam: Your provider will examine your knee to see if you have pain with palpation on the inside of your knee. They'll also apply pressure (stress) your MCL to see if it’s loose, which often means your MCL is torn.

  • MRI: An MRI (magnetic resonance imaging) uses a large magnet, radio waves and a computer to make detailed images of your organs and bones. An MRI is the imaging test of choice for MCL tears. It can help your provider see if you have any other soft tissue injuries in your knee.

  • Ultrasound: Ultrasound uses sound waves to take pictures inside your body. An ultrasound can help your provider see how severe your MCL tear is and if you have any other injuries in your knee.

  • X-ray: Your provider may take an X-ray of your knee to make sure you don’t have any broken bones or other injuries in your knee.

Non-surgical treatments

Most people who have an MCL tear recover from nonsurgical treatment. This is because your MCL has a good blood supply, which makes it easier for your tear to heal. 

 

Nonsurgical treatment for an MCL tear can include:

  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Wearing a knee brace: Your provider may have you wear a knee brace that prevents your knee from moving side to side so that your MCL can heal.

  • Using crutches: Your provider may have you use crutches to walk so that you can limit the amount of weight you put on your affected knee.

  • Doing physical therapy: Your provider will most likely have you do physical therapy exercises to improve your strength and range of motion in your knee. Exercises may involve strengthening your thigh muscles, cycling and doing resistance exercises. If you have an MCL tear and play a sport, your healthcare team will tailor your physical therapy to the types of movements you do for the sport that you play.

 

A grade 1 MCL tear (minor tear) can usually heal on its own with rest within one to three weeks. Grade 2 and grade 3 MCL tears, which are more severe, need proper treatment in order to heal, which can include resting, wearing a knee brace and doing physical therapy. If you injure your knee, contact your healthcare provider as soon as possible.

Surgery