MEDIAL COLLATERAL LIGAMNET (MCL) INJURY TREATMENT PERTH

Non-Surgical and Surgical Treatments – A patient’s guide:

 Dr Arash Taheri

MBBS (Hons), BMedSci (Hons), FRACS (Orth)
Orthopaedic Surgeon

Medial Collateral Ligament (MCL) Injury Treatment Perth

“My aim to ensure you fully understand your diagnosis and treatment options available to you and your unique medical situation.”

Please feel free to ask any questions and bring a family member or friend along for support.

Dr Arash Taheri – MBBS (Hons), BMedSci (Hons), FRACS (Orth)
Orthopaedic Surgeon.

Medial Collateral Ligament

Ligaments are bands of tough elastic tissue around your joints that connect bone to bone, give your joints support, and limit their movement.

The Medial Collateral Ligament (MCL) is one of the four ligaments that is critical to maintaining the mechanical stability of the knee joint.

The MCL helps to connect the thigh bone (femur) to the shin bone (tibia) and is found on the inside of the knee and acts to control sideways movement and keeps the knee from bending inward.

The Medial Collateral Ligament is one of the most commonly injured knee ligaments.

When your outer knee is hit very hard, the MCL, which runs along your inner knee, can stretch out far enough to strain or tear.

You can hurt your MCL during activities that involve bending, twisting, or a quick change of direction and particularly in sports with lots of stop-and-go movements, jumping, or weaving.

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Medial Collateral Ligament Injury Symptoms

Most people who tear their MCL feel pain and hear a “pop” in their knee when the injury happens. The inside of the knee usually swells soon after the injury.

A Medical Collateral Ligament injury is graded I, II or III depending on the level of injury severity as follows:

Grade I – A grade I tear consists of a small tear (10% or less) in the MCL, with some tenderness but no knee instability.
Grade II – A grade II tear is characterised by more pain and swelling than a grade 1 tear but no knee instability.
Grade III – A grade III tear is a complete severing of the MCL, resulting in knee instability, significant pain and swelling and difficulty bending the knee.

After the swelling goes down, the person can usually walk, but feels pain when the inside of the knee is stretched. The knee may also feel unstable and can “give way” and make the person stumble or fall.

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How is a Medial Collateral Ligament Injury Diagnosed?

A Medical Collateral Ligament Injury is commonly diagnosed by:

  • A Medical Consultation – Your medical history is taken and an examination of the knee performed by a medical professional
  • X-ray – An x-ray of the knee joint may help confirm MCL injury diagnosis
  • Magnetic Resonance Imaging (MRI) – An MRI scan of the knee may be useful to more accurately diagnose the injury and help determine if additional structures within the knee have been damaged (e.g a multi-ligament knee injury or injury to the meniscus).

Dr Taheri may use a combination of diagnostic tools to help ascertain the extent of the knee injury and determine the most appropriate treatment options available to you.

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Medial Collateral Ligament (MCL) Treatment Perth

Immediate Treatment

For suspected Medical Collateral Ligament injuries:

  • Immediately take all weight off the injured knee
  • Place a covered ice pack on the injured knee for 10-20 minutes every hour
    • Prop up your leg on a pillow when you ice it or anytime you sit or lie down
    • Try to keep your knee above the level of your heart (this may help reduce swelling)
    • Do this for about 3 days following your injury.
  • Seek professional medical diagnosis and advice as soon as possible regarding further treatment

Non-Surgical Treatment:

Dr Taheri will determine which nonsurgical treatments should be used based on your diagnosis and the severity of your Medical Collateral Ligament tear or sprain.

Most isolated MCL injuries will heal with non-surgical treatment. It’s important to follow the rest, ice, compress and elevate technique to help treat and prevent excessive swelling:

Rest – Activities that excessively irritate the knee, such as pivoting and walking, should be avoided until the symptoms improve
Ice – Apply ice packs to the knee to help reduce swelling and decrease pain (10-20 minutes every hour)
Compression – Wearing a firmly wound, elastic bandage around the knee can help reduce excessive swelling
Elevation – Keeping the knee propped up above the waist can help decrease swelling.

Other non-surgical treatments that may help include:

Pain and anti-inflammatory medication – Please take as directed by your doctor.
Knee braces and crutches –
Dr Taheri may recommend you use a hinged knee brace for a period of time and/or the use of crutches.
Exercise – See recovery information in the recovery section below.

Surgical Treatment:

Surgical treatment of an MCL injury is usually the last resort and will depend on the severity of MCL injury. Surgery is only usually recommended for high-grade injuries or when the injury is part of a more complex problem.

If surgery is the recommended option, Dr Taheri will discuss with you the exact nature of the surgery and your expected recovery timeframe. In general, full recovery after isolated MCL reconstruction will take 6 months.

Medial Collateral Ligament Surgery

If MCL Surgery is necessary, Dr Taheri will recommend and discuss in detail MCL augmentation or MCL reconstruction.

MCL augmentation procedure involves repairing the torn ligament with sutures and/or using one of the patient’s hamstring tendons to reinforce the repair.

MCL reconstruction is reserved for patients with a severe or long-standing ligament damage. A reconstruction procedure uses either a donor graft or a hamstring graft harvested from the patient. The graft is placed in the exact location to replace the torn ligament with new tissue. The graft is then secured with anchors and/or screws placed into the bone that contain strong sutures.

Both MCL augmentation and reconstruction surgery techniques are highly effective at repairing the damaged area and restoring knee stability.

Recovery from MCL Reconstruction Surgery

Recovery times may vary from patient to patient for a number of reasons including age, current heath, muscle and bone strength and commitment to rehabilitation amongst many other factors.

Surgery – The surgery itself usually takes around one hour and is usually done under general anesthestic.

Post-surgery – It’s day surgery so you will be observed for a couple of hours to ensure that you have recovered from the anaesthetic and discharged from hospital.

A friend or family member will need to pick you up from the hospital and stay with you on the night of your surgery. You will probably feel a bit sleepy and might need some pain killers.

You will be given instructions on:

  • Wearing a brace on your knee
  • Warning signs to look out for
  • Wound care and dressings

Physiotherapy recovery program – You will see a physiotherapist and be prescribed a rehabilitation program after your surgery. Prior to discharge you will be given exercise instructions and practice on how to best perform daily activities including climbing stairs, bathing, getting into and out of cars etc.

Hospital stay length – In most cases it’s day surgery. It may be longer depending on your individual circumstances.

Movement after surgery – Moving around with crutches is recommended for the first 4-6 weeks for comfort, safety and confidence. The crutches can be discarded as soon as you are confident to do so and you are happy to weight bare on your knee.

Will I need time off work – Depending on occupation you may require a number of weeks off work and return to light duties. You can be driven in a car as a passenger immediately on discharge from hospital.

Everyday activities – It may take between 6-12 months to recover from surgery. This is dependent on a number of aspects including ongoing commitment to your rehabilitation program, age, current health, muscle and bone strength and other factors.

Driving – Patients may be able to drive a car no earlier than 3-6 months after surgery (it is best to be cleared by your doctor before doing so).

Patients MUST be able to perform an Emergency Stop and short car trips only are recommended initially. The decision to drive after surgery remains the responsibility of the patient.

Air travel – Air travel may be undertaken soon after you are cleared by your surgeon.

What Activities can I Return to After Rehabilitation? 

What activities can you perform after MCL Reconstruction Surgery Once recovered and rehabilitated, there are very few restrictions on activity after Medial Collateral Ligament Reconstruction surgery. You can participate in activities such as walking, cycling, skiing and tennis.

Running and impact sports – High impact pursuits such as running should not be performed for 6 months or more after surgery. Your suitability for returning to running activities depends on the nature and intensity of the sport or activities you are undertaking.

Some activities may place the knee joint at risk (for example extremes of joint flexion and rotation in some advanced yoga postures) – if you are unsure please check with us prior to recommencing your desired activity.

Knee monitoring – Monitoring how your knee performs overtime is essential to your rehabilitation program. Follow up appointments will be scheduled in soon after surgery.

What are the Risks of MCL Reconstruction Surgery

MCL Reconstruction Surgery risks – MCL Reconstruction surgery is generally safe, and serious complications are uncommon.

Serious wound infection occurs in less than 1% of patients.

As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the knee. Medical complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications that may include:

  • Allergic reactions to medications
  • Blood loss requiring transfusion – Low risk of disease transmission
  • Heart attacks, strokes, kidney failure, pneumonia and bladder infections
  • Complications such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation or rarely death

Risk of Infection – Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1 percent. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate the infection.

Blood Clots (Deep Venous Thrombosis) – These may travel to the lung (Pulmonary embolism) and can occasionally be serious and even life threatening. If you get pain or shortness of breath at any stage, you should notify your surgeon.

Fractures or Breaks in the Bone – Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.

Wound Irritation or Breakdown – The operation may cut some skin nerves, so you will inevitably have some numbness and potential aching around the wound. This will not affect the function of your knee. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.

Damage to Nerves and Blood Vessels – Rarely these can be damaged at the time of surgery. If recognised they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement and can be permanent.

Pain relief – You will be given pain relief during your stay and either medication or prescriptions to go home with to keep you comfortable. Paracetamol and an anti-inflammatory (if tolerated) are the mainstays for pain relief.

Dr Taheri will discuss your concerns thoroughly prior to surgery.

If you have any questions, please contact my team at Joondalup Orthopaedic Group.

Dr Arash Taheri – MBBS (Hons), BMedSci (Hons), FRACS (Orth)
Orthopaedic Surgeon.