Feature Story
Treatment of medial collateral ligament injuries
Question: I was recently involved in a twisting injury
along the boards in Captain’s practice. I was told that I have a Grade II MCL
tear. What can I do to get back to the ice for my high school tryouts?
Answer: It appears
that you have partially torn the medial collateral ligament, also called the
MCL. Luckily, most people who injure their medial collateral ligament have a
complete recovery once they have been properly rehabilitated. The MCL is one of
the strongest ligaments in the body. It is most commonly injured when an
athlete sustains a direct contact injury to the outside of their knee which
stresses and ultimately tears the ligaments on the inside of the knee.
Injuries to the MCL are graded I, II and
III. Grade I injuries are mild sprains, while grade II are partial tears to the
MCL. Complete tears to the MCL are grade III. While
the majority of the athletes who sustain MCL injuries do not require surgery,
occasionally some athletes with a grade III MCL tear may need surgery if they
do not go on to heal.
Our treatment protocol for these injuries
at the
Once the initial phase of treatment is
completed, further treatment should be started with the aim of getting you back
to competition as soon as possible. Quadriceps sets, where the quadriceps
muscles are tightened similar to how they would be tightened if you performed a
straight leg raise, where the muscle is held tight for 6-8 seconds, are
performed hourly. Straight leg raises are also initiated immediately. It is
important to start these exercises as soon as possible to prevent quadriceps
muscle atrophy.
Once one can bend their knee enough, we
have our athletes get on an exercise bike. It has been demonstrated that early,
repetitive cycling motion helps the MCL to heal. We place our Gopher athletes
on a stationary bike as soon as they can tolerate it and increase the time on
the bike based on the amount of swelling of the knee.
Athletes are followed closely and
monitored for advancement in their protocol. They are allowed to return back to
competition once they have regained full strength, have no swelling of the
knee, and have evidence of MCL healing on the physical exam. The general time
frame we find for a return back to competition is 1-2 weeks for grade I tears,
3-4 weeks for grade II tears, and 4-6 weeks for grade III tears. A complete
protocol for this treatment can be reviewed on our website at
sportsdoc.umn.edu.
In your case, I would first recommend
that you make sure all of your swelling and pain are under control. You should
then get on an exercise bike and work hard to regain your overall strength. If
you have any trouble at any stage of your rehabilitation, you should check back
with your team trainer or physician for reassessment to make sure there are no
other associated injuries present.
Dr. Rob LaPrade,
MD, PhD, is the team physician for the