Anatomy & Background
Ligaments are tissues made up of fibrous bands of collagen, that join a bone to another bone. Stability and limited excess motion are what ligaments provide joints. The knee contains four main ligaments: the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL) ligaments. Each of these ligaments performs a specific role in creating stability in the knee. If a ligament is injured, both the function and stability of the knee can be drastically reduced.
There are three grades of ligament damage:
Grade I is considered a sprain of the ligament. The actual ligament experiences no tear. Individuals with a grade I injury experience minimal symptoms, but may report feeling pain near the ligament and a tenderness to the touch. The knee may feel stiff. Activities that stress the joint may cause some discomfort.
Grade II injuries are partial tears of the ligament. Individuals may experience pain, tenderness, swelling and have difficulty flexing or extending the knee. There can be a feeling of the knee “giving out” and instability when performing twisting motions. There may also be some laxity or looseness of the joint when tested.
Grade III ligament injuries are full tears. Individuals can experience pain, swelling and loss of range of motion in the knee. There is a prominent feeling of instability and “giving out” of the knee when weight is placed on the joint. The use of a knee brace may be required to help stabilize, rest and heal the ligament and joint. There is significant laxity when the joint is tested.
Grade IV is called a “medial column injury” due to the injury affecting more than just the medial collateral ligament (for example: the meniscus or ACL). These injuries can require surgery. Grade IV injuries must be diagnosed by a specialist to identify the severity of the injury.
Medial Collateral Ligament
The medial collateral ligament (MCL), also known as the tibial collateral ligament, is found on the inside of the knee. The MCL attaches the medial aspect of the femur to the medial aspect of the tibia. The purpose of the MCL is to prevent medial opening or gapping of the knee joint. The medial collateral ligament is connected to the medial meniscus. Individuals who suffer injuries to the MCL may also end up damaging the medial meniscus, resulting in tears to both areas.
Causes
This injury is usually caused by a direct impact to the outside of the knee. The impact causes a sudden gaping force on the inside of the joint. The medial collateral ligament may become stretched or torn due to the sudden impact. The greater the impact, the worse the ligament injury. The highest incidence of collateral ligament injuries occurs between the ages of 20-34 and 55-65, but they may happen at any age.
Treatment Plans
If you think you have suffered this type of injury you should begin treatment by starting the following steps:
- Rest, to avoid causing more irritation and inflammation to the knee.
- Immobilize the knee to prevent further injury. This will also help to promote healing, if the knee is positioned correctly. Depending on the severity of the injury, it may need to be immobilized for a period of time.
- It is recommended to ice the knee to reduce inflammation and help ease pain. Continue icing the injury for the first 48-72 hours. When applying ice do NOT apply the ice directly on to the skin. Use the ice intermittently throughout the day. Do NOT apply heat to any of the affected areas.
- It is imperative you contact your doctor for a complete diagnostic evaluation of the injury.
Pain Management
After an injury to the ACL, you should seek a full evaluation from a pain management specialist or licensed health care provider. Treatment may consist of the following:
- Clinical evaluation including a physical exam, X-rays and MRI in Grade III and Grade IV injuries.
- Use of ice and immobilization to help stabilize and rest the joint.
- Anti-inflammatory medication and other pain medications.
- “Progression,” an immobilizing device to help stabilize the joint.
- Surgery may be indicated for certain ACL tears
Prognosis
Time frames for recovery vary depending on the severity of the injury. Grade I injuries may take from two to four weeks to completely recover. Grade II injuries can take up to four to six weeks. Grade III injuries, being more severe, also take the longest to heal – anywhere from three to four months. Since a Grade IV injury requires surgery, a physician will base recovery time on the injuries that have occurred.
