T&O: MCL Tear

Question 1

Outline the physiology of the MCL

Answer 1

Most commonly injured ligament of the knee

Primary function is to act as a valgus stabiliser of the knee

Question 2

Outline the aetiology of an MCL tear

Answer 2

Most often injured when external rotational forces are applied to the lateral knee, such as a football tackle impacting to the outside of the knee

Question 3

What are the grades of an MCL tear?

Answer 3

Grade I = mild injury, with minimally torn fibres and no loss of MCL integrity

Grade II = moderate injury, with an incomplete tear and increased laxity of the MCL

Grade III = severe injury, with a complete tear and gross laxity of the MCL

Question 4

What are the symptoms of an MCL tear?

Answer 4

Hear a ‘pop’

Immediate medial joint line pain

Swelling

Increased joint laxity

May be able to weight bear

Question 5

How would you investigate an MCL tear?

Answer 5

Valgus stress test = increased laxity

X-ray = exclude a fracture

MRI = gold standard

Question 6

How would you manage an MCL tear?

Answer 6

Grade I Injury = RICE, NSAIDs, strength training, aim to return to full exercise in 6 weeks

Grade II Injury = Analgesia, knee brace, weight-bearing/strength training, aim to return to full exercise in 10 weeks

Grade III Injury= Analgesia, knee brace, crutches, any associated distal avulsion then surgery is considered, aim to return to full exercise in 12 weeks

Question 7

What are the complications of an MCL tear?

Answer 7

Instability in the joint

Damage to the saphenous nerve