Injury to the inner ligament of the knee (MCL).
Diagnostics, treatment and rehabilitation.Â
An injury to the medial ligament of the knee is one of the most common ligamentous knee injuries. Given its extra articular location, the medial ligament generally has good reparative capacity. For this reason, the medial ligament is often successfully treated conservatively.Â
However, there are also certain situations where the risk of permanent instability is greater. With a grade III injury, surgical repair is often unavoidable, especially when the distal portion of the medial ligament is damaged. Debate remains about the optimal treatment of a grade III injury, but it is generally accepted that surgical intervention is necessary to prevent permanent instability. Surgical repair of the distal MCL has the advantage that rapid and safe rehabilitation can be initiated. It prevents permanent valgus instability in most cases and causes fewer complications than if larger reconstructions are required later. But the choice of whether or not to operate is complicated in many cases by additional injury to other ligaments. In about 78% of cases, there is additional ligamentous injury.Â
With these combined injuries, a staged approach is often adopted. This means that when there is damage to the anterior cruciate ligament, for example, it is reconstructed later to give the medial ligament a chance to recover conservatively. Other views again advocate an integrated approach, treating multiple injuries simultaneously, depending on the severity of the injury and the specific needs of the patient.
Unfortunately, there is no standard solution for this injury. Each patient and injury requires an individual approach, carefully weighing both conservative and surgical options. But the goal remains unchanged. And that is a safe and effective path to a stable and functioning knee
Anatomy of the medial band
The medial collateral ligament (MCL) is one of the most important structures that provide stability in the knee during sports. The medial ligament consists of superficial and deep fibers, with the superficial fibers particularly acting as the primary stabilizer against valgus stress and the deep part of the medial ligament consisting of the meniscotibal ligament and meniscotibal ligament playing a secondary stabilizing role.Â
Superfiscial medial band
The superficial MCL (sMCL) has one femoral and two tibial attachments. The femoral attachment point is located on the medial epicondyle of the femur. The proximal tibial attachment seamlessly merges with the tendon of the semimembranosus muscle, while the distal tibial attachment lies on the posteromedial edge of the tibia (tibia). Together, these attachments form a solid network that is crucial for joint stability.
Deep medial band
The deep layer of the medial ligament is composed of two specific ligaments: the meniscofemoral ligament and the meniscotibial ligament.
- The meniscofemoral ligament has its origin just below the superficial MCL on the femur and runs to the medial meniscus. This ligament supports the connection between the femur and the meniscus, which is important for joint stability.
- The meniscotibial ligament is shorter and thicker. It runs from the medial meniscus to the distal edge of the articular cartilage of the medial tibia plateau. This ligament helps hold the meniscus firmly in place and plays a key role in maintaining the medial stability of the knee.
Diagnosis in medial ligament injury
After injury to the medial ligament, it is important to properly assess the severity of the injury. This is because the prognosis greatly influences the treatment plan. Different degrees are distinguished when trying to classify medial ligament injuries. Grade 1 injury is a mild strain where the fibers are not torn. Grade 2 is a partial (partial) tear/damage and at grade 3 we are talking about a complete rupture of the medial ligament. The mechanism behind these injuries usually includes a sudden especially external valgus force or rotation of the knee, which puts great pressure on the medial structures. Larger injuries may involve additional damage to the posterior oblique ligament or cruciate ligaments.Â
The way medial ligament injury is diagnosed is evolving. Ultrasound has become increasingly common in recent years because of its ability to assess ligaments in real time. It provides a detailed view of both the superficial and deep layers of the medial ligament. We know that ultrasound can be an accurate and cost-effective alternative to MRI, especially in grade 2 and grade 3 injuries. During an ultrasound evaluation, one can distinguish between the different layers of the medial ligament.
 The superficial layer is visible as a linear, thin structure extending from the medial femoral condyle to the tibia, while the deep layer is closer to the joint capsule and often less visible due to its proximity to the medial meniscus. Injuries in the superficial layer often involve thickening or discontinuity, while deep lesions may involve fluid accumulation in and around the joint capsule.Â
Treatment of MCL injury
Treatment of MCL injuries depends on the severity and structures involved. For mild or moderate injuries (grade 1 or 2), a conservative approach is usually taken. This includes rest, physical therapy, wearing a brace and targeted exercise therapy to restore strength and stability. With a Grade 3 injury or combined damage to other ligaments, such as the anterior cruciate ligament, surgical intervention may be necessary to restore knee stability. The recovery process after an MCL injury can range from several weeks for mild injuries to months for severe damage.
Bone bruising in medial ligament injuries
In short, an injury to the inner ligament of the knee requires accurate diagnosis and a treatment plan tailored to the severity of the injury and the structures involved. With the emergence of ultrasound as a diagnostic tool and the introduction of innovative therapies, the possibilities for recovery continue to improve. At Physio Vital we strive to incorporate these advances into our approach so that our patients can recover and return to their daily activities or sports not only faster, but safer.
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