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Medial collateral ligament injury of the knee

William W Dexter, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


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 adult with knee pain likely of musculoskeletal origin" 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 [1]. 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 [4]. 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) [5].

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 [7]. 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 [6].

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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Literature review current through: Nov 2017. | This topic last updated: Jan 19, 2017.
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