Medial band knee(MCL)

An injury to the medial knee ligament is usually caused by a force pushing the knee inward, causing the ligament to stretch too far or tear partially or completely. This can result from direct contact, such as a tackle or collision where an opponent bumps against the outside of the knee. Such injuries are common in contact sports such as football and rugby, where physical duels are inevitable.

Apart from direct trauma, an MCL injury can also occur due to incorrect movement without external impact. This happens, for example, when an athlete suddenly changes direction while keeping the foot firmly on the ground, causing extreme stress on the knee ligament. This type of injury is common in sports such as basketball, tennis and skiing, where turning movements and abrupt stops play a major role.

Sometimes the medial knee ligament is overstretched due to an incorrect or unstable landing after a jump. This can lead to the knee moving too far inwards and the ligament being stretched forcibly. Prolonged overuse can also cause damage, especially in people with incorrect posture or abnormal leg position. When the knee ligament is under tension for a prolonged period, it can lead to weakening of the tissue, increasing the risk of injury.

Some people are at greater risk of medial knee ligament injury than others. Athletes in contact sports such as football, rugby and basketball have an increased risk due to collisions and tackles. Skiers are often exposed to twisting movements, which puts extra stress on the knee. Tennis players and other athletes who make rapid changes in direction may also suffer an MCL injury due to the forces involved.

Fatigue can also be a risk factor, as muscles offer less control over the joint, making the knee more vulnerable. Previous knee injuries increase the risk of new injuries, especially if rehabilitation is incomplete. For example, an anterior cruciate ligament injury can lead to additional MCL damage, as the ligaments work together to maintain stability. 

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 fibres, with the superficial fibres particularly acting as the primary stabiliser against valgus stress and the deep part of the medial ligament consisting of the meniscotibal ligament and meniscotibal ligament playing a secondary stabilising role. 

Superfiscal 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 keep the meniscus firmly in place and plays a key role in maintaining the medial stability of the knee.

The severity of an MCL injury ranges from a mild strain to a complete tear. In a mild injury, the ligament is stretched but not torn, leading to pain on the inside of the knee without severe instability. Swelling is minimal and the knee remains largely functional. Usually, the knee recovers within a few weeks with physiotherapy focused on muscle strengthening and stability.

In a partial tear, some fibres are damaged, causing more pain and swelling. The stability of the knee is reduced, especially with lateral movements. Turning and jumping can be painful. In this case, longer rehabilitation is needed and a knee brace is sometimes used to prevent further damage.

A complete tear of the medial knee ligament leads to severe pain and instability. The knee can no longer take normal loads. There is often additional damage to the meniscus or cruciate ligaments. If conservative treatment does not restore sufficient stability, surgery may be required, followed by intensive rehabilitation to restore the knee's functionality.

Ultrasound is a quick and painless diagnostic tool to assess the MCL. It helps determine the severity of the injury and provides dynamic insight into the degree of instability. This contributes to an accurate diagnosis and a targeted treatment strategy.

Surgical repair of the distal MCL has the advantage that a quick and safe rehabilitation can be started. It prevents permanent valgus instability in most cases and causes fewer complications than if larger reconstructions are required later. But the decision to operate or not is also made in many cases based on additional injury to the other ligaments in the knee. In about 78% of cases, there is additional injury. That is, there may also be damage to the anterior cruciate ligament, for example. 

In these combined injuries, a staged approach is often adopted. This means that if 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 approach where multiple injuries are treated simultaneously, depending on the severity of the injury and specific needs.

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.