Reading Time: 10 min read 
Published: 12/02/2024 
Last Updated: 18/02/2024 
Your medial collateral ligament (MCL) is one of the ligaments that stabilises your knee and keeps your shin bone (tibia) in the right place. If this ligament is stretched or torn but still intact, it’s known as an MCL sprain.
If you’ve sprained your MCL, you may experience symptoms like pain, weakness and instability in your knee. In this article, we’ll discuss how MCL sprains happen, which symptoms you may be experiencing, how MCL sprains are diagnosed and the best treatment options to get you back to full fitness.
Struggling with knee symptoms and looking for an expert assessment as soon as possible? Rapid assessment, diagnostic imaging and treatment for MCL sprains are available at Harley Street Specialist Hospital.
What is an MCL sprain?
Your MCL is a ligament in your knee that connects your thigh bone (femur) with your tibia. It helps to keep your knee stable – your MCL and lateral collateral ligament (LCL) limit the sideways movement of your knee. The MCL is the most commonly injured ligament of the knee [1].
If your knee is pushed inwards or you twist with a planted foot, pressure on your MCL can cause it to stretch or tear. This is called an MCL sprain, and a complete tear is called a rupture. People often injure their meniscus (knee cartilage) or anterior cruciate ligament (ACL) at the same time as their MCL. 40% of all knee injuries include the MCL [1].
MCL tear grading
- Grade 1 – This is a mild tear. Your knee still feels supported, and less than 10% of the fibres in your ligament are torn. You’ll probably have some mild pain, and the tear is likely to heal in 1-3 weeks. You may not need any treatment.
- Grade 2 – This is a moderate tear, and your knee may feel loose or unstable. You’ll have moderate or intense pain, and it will likely take 4-6 weeks to heal with treatment.
- Grade 3 – This is a complete tear; your knee will probably feel very unstable. You may have severe pain and other injuries, like an ACL tear or meniscus tear. A grade 3 MCL tear usually takes at least 6 weeks to heal and will require treatment, often surgery [1].
How do you sprain your MCL?
MCL sprains and tears are common in sports. A typical cause of MCL sprains is a hard knock to the outside of your knee when playing sport, which forces your knee inwards.
The force of the impact to the outside of your knee can stretch your MCL so far it tears. This is most common in contact sports such as wrestling, hockey, judo and rugby [2].
Other movements that can injure your MCL include:
- Squatting
- Lifting heavy weights
- Jumping and landing with your knee in the wrong position
- Quick turns and stops, like in football, skiing or basketball
- Hyperextending (over-straightening) your knee, which can happen in skiing
You can also have a gradual MCL sprain that happens over time. Regular stress and pressure on your knee can cause your MCL to tear eventually.
Symptoms of an MCL sprain
You may experience knee pain if you’ve sprained your MCL, particularly with twisting movements. You may hear a pop at the moment the knee is injured.
You’re likely to have tenderness along the inside of your knee (where the ligament is) when you touch it. You may find it hard to walk or struggle to take weight through the affected leg.
Depending on the severity of your sprain, you may experience knee stiffness, swelling and bruising. Your knee may feel unstable, and you may be worried that it will give way.
Your knee may catch or lock as you move around. This could also be a sign that you’ve injured your meniscus [3].
Diagnosis of an MCL sprain
If you think you’ve injured your MCL, getting the correct diagnosis is essential. Clinicians at Harley Street Specialist Hospital will conduct a physical exam of your knee and arrange diagnostic imaging if needed. This can usually be done on the same day.
Your doctor or physiotherapist will examine how you’re walking, any swelling around your knee and will feel your knee for pain. They may test your knee by pushing it inwards to see if this shows any instability or brings on your symptoms.
Imaging that may be recommended includes:
- MRI – If an MCL sprain or tear is suspected, an MRI is usually the first choice of imaging. An MRI can show MCL damage, and your clinician will be able to see how bad the tear is.
- X-ray – X-rays don’t show MCL damage, but they can rule out a broken bone. However, a stress X-ray can be useful for diagnosing MCL tears. This is where your doctor gently pulls on the inside of your knee to see if it opens up further than it should. If the X-ray shows an abnormally large gap between your femur and tibia, you are likely to have an MCL tear.
- Ultrasound – Ultrasound scans show MCL damage, but in less detail. However, they can be useful for rapid assessments and assessing other damage to your knee.
Early management of an MCL sprain
If you think you’ve injured your MCL, the POLICE principle can guide your initial management of the injury. You can use this principle to treat any soft tissue injury to your knee, not just an MCL sprain, so you don’t need to worry about whether you’ve diagnosed yourself correctly.
Here’s what POLICE stands for:
- P: Protect – You need to protect your injury from any further damage. Rest immediately after your injury, but not for too long. Depending on the injury, you may consider using some type of support or splint.
- OL: Optimal Loading – After your initial rest, you need to get active again once you feel able to move. Start putting weight on your injured leg and working gently on your knee’s range of movement. This should be a gradual process with minimal pain, guided by what feels right for you.
- I: Ice – Place some crushed ice, a cold compress or a bag of frozen peas onto the affected area. There should always be a thin layer of fabric between the ice and your skin to avoid skin damage. Do this for 20 minutes every couple of hours, for the first few days following your injury.
- C: Compression – Compress your knee with a bandage to help disperse swelling from the knee joint.
- E: Elevate – Elevate your knee above the level of your heart. The easiest way to do this is to lie flat on your back, with your knee raised up on pillows or the arm of a sofa. Stay like this for at least 20 minutes and repeat several times a day to help reduce swelling around the knee.
In the first three days following your injury, there are certain things you should avoid. These can be remembered as HARM; here’s what it stands for:
- H: Heat – Avoid hot packs, showers, saunas, heat rubs and hot baths.
- A: Alcohol – Avoid drinking alcohol while you’re recovering. Research shows that drinking alcohol can slow healing from injuries [4]. Drinking alcohol can also mask your symptoms and increase your risk of injuring yourself further.
- R: Running – Avoid running and exercise of a similar intensity to running.
- M: Massage – Although massage can be helpful in the later stages of healing, it’s best avoided in the few days immediately post-injury. Massage can cause more swelling and damage to an area that’s already injured.
Treatment for an MCL sprain
The MCL has a good blood supply and usually responds well to non-surgical treatment. Treatment for an MCL sprain often includes pain relief, bracing and physiotherapy.
Bracing and walking aids
Your doctor or physiotherapist may recommend a lightweight brace to protect your knee and prevent it from moving from side to side. This is usually needed only for a few days, before starting your physiotherapy programme.
You may also be given crutches to use for a few days. This will allow you to get around more easily while protecting your injured knee, but the goal is to progress off these within a few days.
Painkillers
Your doctor may prescribe pain relief or advise you to take over-the-counter pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended, as they help to relieve the pain and swelling that often come with an MCL tear.
Physiotherapy
You’ll be ready to start physiotherapy once your pain and swelling have eased. Physiotherapy for an MCL sprain usually focuses on exercises to restore strength, stability and range of movement to your knee. Exercise has been shown to significantly improve the recovery of MCL injuries [5].
Your physiotherapist will take a history of how you injured your knee and complete a full physical assessment. They will use that information to create a tailored rehabilitation programme for you.
Physiotherapy for MCL sprains can also help prevent further knee injuries in the future by ensuring your knee is strong, stable and flexible. Your exercises may target these muscles:
- Quadriceps (muscles at the front of your thigh)
- Gluteus medius and gluteus maximus (buttocks)
- Hamstrings (muscles at the back of your thigh)
- Abductors (muscles of your outer thigh)
- Adductors (muscles of your inner thigh)
Your physiotherapist will advise whether you need to do these exercises daily or several times per week. Usually, physiotherapy exercises need to be completed for several weeks or months. You may choose to continue the exercises long-term to prevent future knee injuries.
Harley Street Specialist Hospital’s team of private physiotherapists are skilled at treating MCL injuries. Book a physiotherapy appointment today for a full assessment and tailored exercise programme.
Surgery
MCL sprains don’t often require surgery – surgery is more common for a total rupture of the MCL. If you have other injuries alongside your MCL sprain (such as an ACL or meniscus injury), nonoperative treatment is often recommended for the MCL injury [6].
Professional athletes may choose to have surgery for an MCL sprain to reduce the risk of injury when they return to sport. Surgery for an MCL injury is minimally invasive and is usually done via small incisions (cuts) on your inner knee.
MCL repair surgery is either reattachment or reconstruction surgery. In reattachment surgery, the torn part of your MCL is attached back together.
In reconstruction surgery, your MCL is replaced with a graft (replacement tissue), usually from another part of your body, such as your hamstring tendon. A graft can also come from a donor. MCL reconstruction surgery significantly improves knee function and quality of life for people with chronic knee injury or instability following an MCL tear [7].
After surgery, your surgeon will request physiotherapy to strengthen your knee and improve your range of movement. The time taken to recover from surgery is different for everyone, and ranges from a few weeks to a few months.
The total time you’ll need to recover from surgery will depend on the grade of your MCL tear, your age and general health, the type of surgery you had and if you had other injuries or surgery on that knee. When you’ve recovered from surgery, you should be able to return to the activities and sports you did before your injury.
Surgeons at Harley Street Specialist Hospital are adept at treating MCL sprains and tears. If you need surgery for an injured MCL, we can guide you through the process and help you get back to full fitness.
Treating MCL sprains at Harley Street Specialist Hospital
With our skilled clinicians and fully equipped diagnostic imaging centre, we can assess, diagnose and treat MCL sprains in one place. Often, treatment starts on the first visit.
If you think you may have an MCL sprain, or you’ve already been diagnosed and you’d like to start treatment, book an appointment at Harley Street Specialist Hospital.
