MCL Reconstruction
The most common knee ligament injuries often involve the medial aspect of the knee. Within this area, there are several crucial anatomical structures, with the medial collateral ligament (MCL) standing out as the largest and strongest. Many isolated MCL injuries to the medial knee are a result of sports-related activities. These injuries can occur due to either direct contact or non-contact stress applied to the outside of the knee, which can lead to stretching or tearing of the medial knee structures located on the inner side.
The severity of a medial knee injury is categorized based on the extent of tearing, and the choice of treatment depends on factors such as the tear's location and whether other ligaments have also been injured:
Dr. Amit specializes in performing MCL reconstruction for patients with grade III tears. It's important to note that any degree of "looseness" in the medial knee structures can contribute to the failure of an ACL graft. Therefore, when a patient presents with both a medial knee injury and an ACL injury, it is crucial to ensure that the MCL injury has fully healed before proceeding with ACL reconstruction. In some cases, concurrent repair or reconstruction of the MCL may be necessary. In situations involving severe combined knee ligament injuries, particularly when a PCL tear is also involved, addressing the medial knee injury often requires repair, augmentation repair, or a complete reconstruction through MCL reconstruction surgery.
How Long is Recovery Time After MCL Surgery?
In cases of acute MCL injuries, Dr. Amit Meena typically initiates an early rehabilitation program aimed at reactivating the quadriceps, controlling swelling, and restoring knee range of motion. For athletes dealing with isolated acute MCL ligament injuries, a general timeframe for returning to sports can be estimated by multiplying the grade of the injury by two (in weeks). Here's a rough guideline:
Additionally, in acute situations where the knee exhibits significant instability, the use of an MCL protective knee brace is often recommended. It's essential for patients to consult with a brace specialist who can understand their specific goals and provide a properly fitted MCL brace that is durable enough to support their desired activity levels.
Can the MCL heal on its own ?
The MCL is surrounded by other tissues and does have a good ability to heal on its own when it is torn. However, there are some types of MCL tears that commonly do not heal well and need to be followed more closely. These include MCL tears with a multiligament knee injury, MCL tears that are completely torn off of the femur whereby the femur gaps to the outside when the knee is out straight, and those that tear off the tibia. These 3 MCL tears in particular have a much lower chance at healing and need to be followed very closely to see if they do heal. Sometimes proceeding directly to surgery, with the amount of instability that a patient presents with or with a particular type of tear pattern which shows up on the MRI, may be indicated for these circumstances.
Can an MCL tear result in one being able to not bend or straighten their knee?
MCL tears represent a distinct type of knee ligament injury that can result in motion loss following the injury. During the healing process, it's possible for scar tissue to develop, potentially hindering the ability to fully bend or straighten the leg. This underscores the importance of engaging in a structured physical therapy program when dealing with an MCL tear. Such a regimen can greatly enhance the likelihood of not only healing the injury but also ensuring that it heals without causing stiffness in the knee.
How long does it take an MCL tear to heal?
The healing duration of an MCL injury typically correlates with the extent or grade of the tear. In the case of a grade I mild intrasubstance tear with no significant gap in the knee, athletes generally recover within 1 to 2 weeks. A partial tear, classified as a grade 2 tear, where some gapping occurs due to the tear on the outer side of the knee but isn't a complete tear, typically necessitates 3 to 4 weeks for healing. On the other hand, a complete tear, when it eventually heals, often takes about 5 to 7 weeks for athletes. It's worth noting that individuals who do not wear a brace or do not engage in a physical therapy regimen designed for MCL tears may experience longer healing times. Notably, tears that fully detach from the femur or tibia, causing the knee to gap open when straightened, have a higher likelihood of not healing.
What are the symptoms of an MCL tear?
MCL (Medial Collateral Ligament) tears manifest with distinct symptoms, including pain localized on the inner side of the knee, typically in a rectangular-shaped area near the direct inside or medial part of the knee. Patients may also experience a sensation of instability or genuine instability on the outer side of their knee. Additionally, because an MCL tear can exert additional stress on the outer knee, some patients may encounter pain on the outside of the knee. This external knee pain could be attributed to a bone bruise or a tear in the lateral meniscus.
When is the time to see a doctor with an MCL tear?
If you experience a sensation of knee instability, particularly with noticeable side-to-side gapping, it is advisable to consult a physician promptly. Seeking medical attention is essential not only for addressing the MCL (Medial Collateral Ligament) tear effectively with proper treatment and therapy but also to rule out any accompanying injuries that might become problematic if left untreated in the future. Your health and well-being are of utmost importance, and seeking timely medical assessment can aid in a smoother recovery process.
When should one start rehabilitation for MCL tears?
Initiating rehabilitation for MCL (Medial Collateral Ligament) tears promptly upon identification of the injury is crucial. Early rehabilitation focuses on aspects like restoring motion, reducing swelling, and kickstarting muscle recovery. While complete MCL tears often necessitate the use of a brace to prevent them from healing in a lax position, most MCL tears can benefit from immediate physical therapy once diagnosed. This rehabilitation may encompass various exercises, including the use of a stationary bike, which has shown to be particularly effective in aiding the healing process, especially in athletes. Early intervention through rehabilitation plays a vital role in optimizing the healing and recovery process for MCL injuries.
What is the treatment for MCL tear with an ACL tear?
The treatment approach for a combined ACL (Anterior Cruciate Ligament) and MCL (Medial Collateral Ligament) tear typically hinges on the results of a thorough physical examination. When both ligaments are torn, but the knee doesn't exhibit valgus gapping (outward angling) in full extension, there's a good likelihood that the MCL can heal through a 4 to 6-week rehabilitation period. Following this, an ACL reconstruction can be considered.
However, in cases where the MCL is detached from the tibia or completely torn at the femur with significant gapping in full extension, the chances of natural MCL healing are reduced. While attempting a rehabilitation program to regain range of motion and reduce swelling may be beneficial, these patients require close monitoring. In some instances, a combined ACL and MCL reconstruction may be necessary for optimal recovery and knee stability.
What types of braces are best for MCL tears?
We emphasize the importance of bracing for complete MCL tears to prevent any residual looseness during the healing process, which could potentially cause discomfort in the future. Utilizing a hinged knee brace, custom-fitted to each patient's knee, offers the most effective means of ensuring knee stability during the healing phase. This proactive approach helps avoid potential complications associated with a loosely healed MCL over time.
What should one do when they have a complete MCL and PCL tear?
In cases involving a complete tear of both the MCL and PCL, surgery is typically recommended, provided that the physical examination aligns with this course of action and there are no contraindications due to other medical conditions or injuries. It's crucial to understand that these two ligaments are interdependent. If only a PCL reconstruction is performed while leaving the MCL untreated, there is a significantly elevated risk of the PCL reconstruction failing. Therefore, opting for a combined MCL and PCL reconstruction is usually the preferred approach in such situations.
