The medial collateral ligament (MCL) of the knee is one of the strongest ligaments in the body. It stabilizes the inside of the knee with cutting, or lateral movements. The MCL is commonly injured in hockey when there is a blow to the outside of the knee or when a skate gets stuck in the ice and the knee and body continue forward.
There are three levels of sprains, graded I, II and II. Grade I is a mild sprain, with pain and very minimal swelling. Grade II is a partial tear of the MCL and grade III is a complete tear. With grade I sprains, the MCL is stretched but the knee is still stable. Grade II and III sprains demonstrate more laxity at the joint and instability of the knee.
The RICE protocol (rest, ice, compression, elevate) is necessary after initial injury. The goal is to lessen the swelling of the knee as quick as possible for a faster recovery. Initiation of the quadriceps muscle is important to decrease atrophy, so performing quad sets and straight leg raises are crucial. Once the swelling is controlled and you are able to start bending your knee it is important to get on the stationary bicycle, as research has shown, the repetitive cycling motion helps healing of the MCL. Surgery is not usually indicated for MCL sprains unless combined with an ACL and/or medial meniscus tear. It is important to make sure injury is only to the MCL prior to rehabilitation to reduce risk or re-injury or complication.
Time of rehab and return to sport is based on the grade of MCL sprain, with grade II and III sprains taking longer. When ready to return to sport, a brace can be used to support the MCL.
By: John Gallucci Jr., MS, ATC, PT, DPT
President & CEO, JAG Physical Therapy