Medial collateral ligament injuries

ANATOMY&FUNCTION.
 Diagnosis

The medial collateral ligament injury is most •

commonly an avulsion from the femoral side but
mid substance and tibial avulsion tears are also
.seen
The severity of laxity of this medial collateral
:ligament may be described as
Grade I - A hint of laxity •
Grade II - Definite opening of the medial joint line •
-no more than 1 cm by clinical assessment or
.strain radiography
Grade III - Severe opening of the medial joint line •
.more than 1 cm
 Conservative managment for a
mild MCL injury
• grade I and mild grade II
• Week 0-1
• PRICE
• partially weight bearing
. Electrotherapy
.Active flexion/extension exercises begin as
soon as pain allows.( Inner range
quadriceps)
 Week 1-2
• fully weight
• Electrotherapy
• gentle localized
massage over the
injury site.
• Closed kinetic chain
exercises
• Closed kinetic chain
exercises
• proprioceptive balance
 Week 2-3
• The athlete continues with localized pressure
massage. All gym work and strengthening
exercises are progressed, with emphasis on
strength and power. Balance boards and agility
work on the mini-trampoline. Light jogging and
skipping is allowed.
 Week 3-4
• Running distances and speed are increased.
Sports skills and plyometric work are gently
introduced. Proprioceptive work continues with
harder and more prolonged tasks.
 Week 4 onwards
• Athletes must practice sports skills, progressing
over 2 weeks. Athletes normally return to sport
between 4-6 weeks.
 Conservative managment for a
moderate to severe MCL injury
• (severe grade II and grade III):
• The moderate to severe MCL injury must be
protected in a hinged brace for 6 weeks to
allow full healing of the ligament and reduce
the risk of laxity following the injury.
Patients need to be warned that the injury
will be very painful, especially when
working into extension.
 Week 0-2
• non weight bearing on crutches .
• A hinged brace is worn for support and
protection.
• NSAID’s as used as necessary .
• PRICE .
• neuromuscular electrical stimulation .
• Gentle range of movement exercises .
• Thera-Band
• stretching
 Week 2-4
• partially weight bearing
• Electrotherapy
• Closed kinetic chain exercises
• quadriceps and hamstring strengthening
Closed kinetic chain exercises
 Week 4-6
• fully weight bearing but still braced.
Electrotherapy and massage continue.
• knee bends
• isotonic strengthening of quadriceps
• hamstrings
• single leg calf raises,
• and balance exercises on one leg.
 Week 6-8
• The brace is removed.
• patellofemoral joint must be mobilized
appropriately using manual techniques.
• Frictions over the scar tissue may be
necessary plus the use of laser or
ultrasound.
• static bike,. Progressive strengthening of
quadriceps, hamstring, and calf muscles is
undertaken
 Week 8 onwards
• isotonic and isokinetic strengthening
exercises.
• stair-master
• balance work, skipping, agility work, and full
knee bend exercises
• Jogging can be initiated, progressing to
running, sprinting, figure of eight running,
shuttle runs, Sports training and drills start
at 10 weeks onwards and the aim is a return
to sports by approximately 12 week.