CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Medial Collateral Ligament Injury
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Injuries and Conditions: Medial Collateral Ligament Injury : Medial Collateral Ligament Injury : Treatment Options

An injured MCL rarely requires surgery for a full recovery. Differences in the severity of the injury will effect the treatment as well as the activity level of the patient. MCL injuries may range from minor sprains to complete tears of the ligament. A majority of injuries will heal on their own; even complete tears. Non-surgical treatment consists of protective bracing and physical therapy. Occassionaly, however,a torn MCL may not heal, and surgery will be required to reattach or repair the ligament.

Treatment options:

Medial Meniscectomy Surgery Overview
The torn piece of the medial meniscus is removed, and the remaining surface is smoothed. The residual meniscal cartilage continues to serve as a natural shock absorber for the knee.

Evaluation of Patient for Surgery

  • A complete physical examination is given which provides an assessment of the patient's overall health.
  • An examination is given of the range of movement in both the injured and uninjured knee.
  • Strength and walking (gait) ability is measured and analyzed.
  • Knee arthrometry is utilized to measure the tightness and stability of the knee.
  • Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will feel tired and slightly disoriented though the after-effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
  • Post-Operative Instructions:

  • Wear the brace at all times, except when bathing or showering.
  • Bear weight as tolerated in the brace with the knee locked in full extension.
  • Use crutches as needed until stability returns.
  • Ice the knee three times a day for 20 minutes.
  • Keep the wound dry. The dressing can be removed for showering (with the knee wrapped in plastic kitchen film) after four days.
  • Three times a day, for 30 minutes each time, sit with a large towel roll under the heel with the brace locked in full extension.
  • It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following meniscal surgery. If this becomes severe or the patients develops a fever, calf pain, shortness of breath, or chest pain, contact a doctor immediately.

    Surgical Procedure
    The torn section of the meniscus is loose, creating interference with the other structures of the knee. This loose fragment is carefully cut away, leaving as much of the original meniscal cartilage as possible. The remaining cartilage is smoothed along the edge, to provide lateral stability and proper weight distribution.

    Long Term Expectations for Recovery

  • A surgically sutured meniscus which is rehabilitated properly will allow the patient to eventually regain complete strength, stability, motion, and control of the knee.
  • Patients that are in good physical condition are likely to recover within 4 to 6 weeks and will then usually be able to perform at previous levels of intensity.
  • Patients that are in poorer overall condition will also be able to return to previous activity levels, though rehabilitation and physical therapy will tend to be more lengthy and involved.
  • In all cases, physical therapy is required to restore the muscle strength, flexibility and joint stability which was lost due to the injury and the post-injury period or rest and rehabilitation.

    Possible Complications and Risks

  • Re-injury to the meniscus is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing damage to the recent suture.
  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
  • The repaired meniscus is often as healthy as before the injury, and will tend to remain robust if not subjected to abuse.
  • Conservative Treatment of MCL Overview

    Physical therapy is designed to restore strength, stability and range of motion through exercises, stretching and muscle stimulation.

  • The initial goal of therapy is to re-establish a full range of motion in the knee.
  • Ongoing therapy rehabilitates the quadriceps and hamstrings, the surrounding muscles which add strength and control to the joint.
  • Partial or complete tears will require bracing to provide stability to the inner aspect of the knee while the ligament heals.

    Rehabilitation Program
    Patients with mild injuries that are stable with inner knee stress testing are generally treated based on their symptoms, without the use of a brace.

    Rehabilitation focuses on regaining knee range of motion and quadricep/ hamstring strength.

    Patients with moderate to severe instabity during knee stress testing are treated with a brace for 4-6 weeks. This brace is typically hinged to allow a range of motion from 0-90 degrees. Crutches are used until the patient can fully extend the knee and can walk normally without them.

    Range of motion exercises are started early, initially in a pain free arc. Once range of motion is restored hamstring and quadricep strengthening is begun.

    With severe injuries in patients involved in contact sports, such as football, a functional knee brace may be helpful to prevent re-injury when they return to sports.

    Medication and Medical Products
    Knee: Compression SleevesKnee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.

  • Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella

  • Knee BracesKnee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.

    Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.

    Knee braces can be used to treat:

  • Pre-operative ACL/PCL ruptures or injuries
  • Non-surgical ACL/PCL injuries
  • General knee instability
  • Pre/post joint replacement with ligament instability
  • Grade II or III ligament sprains.

  • Long-Term Expectations for Recovery

  • Patients with minor injuries can expect a full recovery within a few days to 4 weeks.
  • Patients suffering partial or complete tears of the MCL will require much longer to rehabilitate, although a full recovery likely. These injuries require up to 3 months to heal.
  • A large percentage of patients will return to their pre-injury level of activity.
  • A small percentage of patients will require surgical repair; however, a majority of these patients will also return to their pre-injury level of activity.

    Possible Complications and Risks

  • Risks are minimal and complications are rare.
  • The most common major complication is re-injury of the MCL, especially in contact sports.
  • Residual laxity(looseness)may develop in patients with moderate to severe injuries that are not braced long enough for the ligament to heal properly. If the laxity limits activity and cannot be corrected with functional knee bracing, surgery may be necessary.
  • Stiffness can develop if patients are immobilized after the injury and if gentle range of motion is not started early.

    Surgical Hardware Considerations

    This condition does not require surgical hardware.

    Factors in Transplant Source
    This condition does not require the transplanting of any tissue.