Pain in your inner knee? It could be an MCL tear (2024)

• Written by Nataraj N

The medial collateral ligament (MCL) situated along the inner knee plays an important role in stabilizing the joint and helping its movement. It ensures that the knee withstands the lateral pressure exerted during everyday activities and athletics, making it prone to injuries.

“MCL is a band-like structure which is attached from the inner side of the femur [thigh bone] to the inner upper portion of the tibia [shin bone],” says Dr Kumardev Rajamanya, head of the department and lead consultant orthopedic, Aster Whitefield Hospital, Bengaluru. “It has two components, a superficial and a deep part. The deeper one is the primary static stabilizer against the valgus rotation of the knee.” 

However, the resilience of the MCL has its limitations. A misstep, sudden twist, or external trauma puts an unwanted pressure and can lead to its tear.

Causes of an MCL tear 

Common causes of MCL tear are stress, biomechanical issues and external trauma. 

“The mechanism of injury most commonly is due to a direct impact on the outer or the lateral aspect of the knee , which can be either due to a road accident or a sports injury,” says Dr Rajamanya.

This is commonly associated with sports involving a sudden change in direction like football, skiing and basketball. The rapid pivoting puts additional rotational stress on the MCL. In contact sports like kabaddi and rugby, the external force pushes the knee inward, which strains or tears the ligaments.

Everyday activities like simple missteps or falls cause the knee to twist unnaturally , and biomechanical issues like imbalanced gait or leg length discrepancies put unusual stress on the MCL.

MCL tear: Symptoms

The tear is graded into different categories based on the severity, with the symptoms varying for each grade.

“An individual will typically have pain and swelling on the inner side of the knee. The symptoms depend upon the severity of the injury,” says Dr Rajamanya.

He  adds, “In grade 1 tear, there is a minor sprain and swelling and minimal pain as only a few fibers are torn, but the knee’s stability is not affected. In grade 2,  a greater number of fibers are torn, so there is slightly more pain and swelling without significantly affecting the stability of the knee. Grade 3 is a complete MCL rupture and severe pain and swelling while the joint becomes unstable.”

A grade 3 tear will also show a bruise with a spectrum of purple and blue patches at the site where the blood vessels are ruptured.

Treatments

MCL tear is treated mostly without surgical intervention. Rest and regular physiotherapy sessions form the cornerstone of the treatment. When accompanied by issues like ACL tear, the need for surgical intervention occurs.

 “Most often, MCL heals without any surgical intervention being required. Gradually, physiotherapy sessions , which include gentle rehabilitation exercises, help strengthen the ligament. Exercises for strengthening the muscles around the knee and the MCL should be done under supervision by a trained physiotherapist,” says Dr Rajamanya.  

Grade 1 tear needs resting, ice packs and a brace to stabilize the knee with an elevation till the inflammation subsides. More severe grade 2 and 3 tears include a more extended period of immobilization with a hinged knee brace to provide support. Physiotherapy sessions focussing on gradually increasing the knee’s range of motion and strength are also required.

How to prevent an MCL tear?

“The first step is to keep your knees strong by doing the exercises suggested by the doctor and demonstrated by the physio. As a safety precaution, using a short-hinged knee brace during heavy strenuous activities helps when one is injury prone,” says Dr Rajamanya.  

A proper warm-up and cool-down routines help increase blood flow to the muscles and ligaments, making them more flexible. Regular stretching helps reduce stress on the MCL during physical activities. Further, core exercises enhance overall balance and stability, reducing undue stress on the knees.

Incorporating proper knee alignment and movement techniques into sports training significantly reduces the risk of MCL injuries. Agility and proprioceptive exercises can improve neuromuscular control and the body’s ability to respond to dynamic situations, while activity-specific, appropriate footwear that provides adequate support mitigates the risk of an MCL tear.

Takeaways

• MCL tear occurs due to excessive stress from trauma or knee twisting in an unusual position , which overpowers its strength and biomechanical issues , putting excessive stress on it.
• Symptoms depend on the severity of the tear. It can range from mild pain and discomfort to bruising and loss of knee stability.  The treatment is tailored depending on the severity of the injury.  
• Prevention includes strengthening the muscles around the knee. Using a brace while doing heavy strenuous activities, adequate warmup and cooldown, and wearing proper footwear also helps.