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Medial Collateral Ligament (MCL) Injury

Other popular names

Who does it affect?

All people, but particularly those engaged in sporting activities.

Why does it happen?

The main restraining ligament on the inside of the knee is the Medial Collateral Ligament (MCL). This is a ligament that is frequently injured when the lower leg is forcibly deviated laterally (away from the body).

Symptoms

Following an injury, pain is normally experienced over the medial aspect of the knee. It is usually associated with some swelling and there is tenderness on examination.

Diagnosis

An MRI scan is often used to confirm the clinical diagnosis and differentiate it from other injuries such as a meniscal tear and identify whether any other structures have been injured as the medial meniscus and ACL are often also inured at the same time as the MCL.

Non-surgical treatment

Fortunately, most MCL injuries will heal well and there is usually no need for surgical treatment. For mild sprains, rest, analgesia and physiotherapy is usually sufficient.  For more severe sprains, the knee  sometimes needs to be supported in a brace to allow the ligament to heal in a good position.

The healing process following an MCL injury takes place over a period of 6 to 12 weeks depending on the severity of the injury.

Occasionally, after the ligament has healed, there can be significant laxity that can give instability symptoms similar to those that occur after an anterior cruciate ligament injury and these might occasionally require surgery.

In addition, the MCL is sometimes repaired or reconstructed acutely in the complex multi-ligament knee injury.

Surgical treatment

MCL reconstruction surgery involves a general or spinal anaesthetic as a day case or overnight stay.

The procedure is usually performed arthroscopically (through keyhole surgery) and is aimed at replacing the deficient MCL with a graft ligament to stabilise the knee.

If reconstruction is necessary then it is reconstructed along the same principles as with an ACL Reconstruction using the medial hamstring tendons with an arthroscopically assisted technique. 

Post-surgery rehabilitation

Most patients are able to return home on the same day as surgery or the following day.  All patients will need someone to take them home and be with them on the night following surgery.

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. 

Patients need to use crutches for the first 2 weeks following surgery although they can fully weight-bear - the crutches are mainly to prevent falls until good muscle control has been regained to the leg.

Dressings

The large bandage around the knee is normally removed 24-48 hours after surgery and a tubigrip to supply gentle compression to reduce post-operative swelling.

The non-stick sterile dressings on the wounds are replaced with clean waterproof dressings .  The larger incision over the site of the hamstring tendon harvest site is closed using dissolving stitches and the paper butterfly sutures overlying this can be peeled away easily after 10 days.

Return to normal routine

Bathing and showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 10 days after surgery.
In summary, whilst the wounds are wet - keep them dry and when the wounds are dry, you can get them wet!

Rehabilitation

Surgery is followed by a prolonged course of physiotherapy. This requires a commitment to undertake this rehabilitation in order to achieve the best possible result (at least half an hour per day for 6 months).  It is vitally important to stay within the post-operative activity restrictions an physiotherapy guidelines to avoid damaging stretching your reconstructed ligament.

Return to work

The timing of your return to work depends on the type of work and your access, however, the following is a general guide:

Driving

When you can walk without crutches or a limp and be in control of your vehicle (about 4-6 weeks).

Risks

MCL reconstruction is an extremely safe and reliable operation. However there is a risk of problems or complications with any surgery.

These risks include:

All these risks are uncommon and in total, the chance of you or your knee being worse off in the long term is about or less than 1%.

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