Tears of the medial collateral ligament (MCL) occur more frequently than tears of other ligaments in the knee. The incidence is up to 3 cases per 1,000 people. The MCL connects the inner epicondyle of the femur to the tibia and is a major obstacle to external tibia deviation (valgus deviation). Deeper portions of the ligament bind the medial meniscus to the femur, which allows for the possible combined injury of these structures. Do I need surgery for my MCL rupture?
The MCL is most commonly injured by the indirect mechanism of tibial hyperextension and outward rotation of the tibia. The force is transmitted to the ligament fibers and a tear occurs, in most cases incomplete. Under direct impact on the external parts of the joint, an excessive tensile force is also applied to the MCL and a complete tear occurs.
Sharp pain, a clicking sound, subcutaneous haemorrhage and swelling of the ligament projection occur. Isolated rupture due to extra-articular location of the ligament does not result in noticeable haemarthrosis. Due to the pain syndrome and instability, the patient is spared the injured leg. The examination reveals painfulness on palpation in the ligament projection, subcutaneous haematoma, and a positive valgus test: increased deviation of the lower leg to the outside compared to the other side.
To rule out intra-articular fractures, radiographs are taken in two projections. The extent of the MCL tear as well as the presence of associated meniscus and other ligament tears is determined by MRI. Even with a ruptured MCL, most cases are treated conservatively: elastic bandaging, local cold, elevated positioning of the limb, limiting the load on the injured leg, and wearing a brace with rigid side pads for 3-4 weeks.
Clear indications for surgical intervention are:
- ineffectiveness of conservative treatment for partial ligament damage;
- complete rupture of the fibers or their detachment from the place of attachment to the bone;
- transverse ligament rupture across the entire width of the fibre;
- instability in the joint due to damage to the meniscus, anterior cruciate ligaments, loose intra-articular bodies;
- chronic sprains;
- chronic sprains; long-standing injuries and recurrent severe pain in the knee joint;
- unclear complaints after previous surgery;
- unsuccessful ligament repairs of damaged ligaments, after which the functionality of the knee has not been restored.