Medial collateral ligament injury of the knee
- William W Dexter, MD
William W Dexter, MD
- University of Vermont College of Medicine
- Director, Sports Medicine Program
- Maine Medical Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Injuries of the medial collateral ligament (MCL), also referred to as the tibial collateral ligament, occur frequently in athletes, particularly those involved in sports that require sudden changes in direction and speed, and in patients struck on the outside of the knee. Most heal well with conservative treatment, but some are associated with other significant injuries and careful evaluation is needed.
The evaluation and management of MCL injuries is reviewed here. A general approach to the patient with knee pain and the management of other types of knee injuries are discussed separately. (See "Approach to the athlete or active adult with knee pain" and "Anterior cruciate ligament injury" and "Meniscal injury of the knee" and "Lateral collateral ligament injury and related posterolateral corner injuries of the knee" and "Posterior cruciate ligament injury".)
According to one systematic review, studies of the epidemiology of knee injuries are deeply flawed and should be interpreted cautiously . Nevertheless, ligament injuries account for up to 40 percent of all knee injuries, and of these, medial collateral ligament (MCL) injuries appear to be the most common [2,3]. MCL tears accounted for 7.9 percent of all injuries in an observational study of 19,530 knee injuries in 17,397 athletes over a 10 year period . The precise incidence of MCL injuries is unlikely to ever be known because many low grade injuries go unreported. While still common, MCL injuries declined in number during the course of an 11-year study of injuries in the Union of European Football Associations (UEFA) .
Given the limitations of the medical literature, it is not possible to determine the exact risk of MCL injury by sport. Football (ie, soccer) and basketball players appear to have a relatively high prevalence, as do participants in contact sports such as wrestling, hockey, and rugby [1,6]. Whether the risk of MCL injury varies significantly by gender remains unclear, some studies suggest that females are at higher risk [1,6]. A large survey study of United States high schools reported that females had a higher risk for knee injury than boys playing the same sport . Data from a prospective study of cadet athletes at the United States Military Academy suggest a significantly higher risk for isolated MCL injury among female intercollegiate athletes .
Other potential risk factors of note include prior injury, higher level of play (eg, intercollegiate athletes are at higher risk than secondary school athletes), game participation (versus practice), and type of sport. Various other risk factors have been proposed ranging from equipment (eg, ski bindings) to different shoe-surface interfaces, but no definitive data exist to confirm these claims. (See 'Mechanism of injury and healing' below.)
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- MECHANISM OF INJURY AND HEALING
- PHYSICAL EXAMINATION
- Overall approach
- Range of motion
- Special tests and grade of injury
- Magnetic resonance imaging
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP AND REHABILITATION
- RETURN TO SPORT
- Prophylactic bracing
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS