Knee Pain
MCL Tear
A medial collateral ligament (MCL) tear is a common knee injury. It most often happens to people who play sports like football, basketball and skiing. MCL tears are most often treated without surgery, though there are surgery options.
The MCL is a major ligament that’s located on the inner side of your knee. The tear can be partial (some fibers in the ligament are torn) or complete (the ligament is torn into two pieces).
MCL tears can be classified into three grades:
Grade 1: A mild tear in which less than 10% of fibers in your ligament are torn and your knee is still stable. You’ll likely have some tenderness and mild pain if you have a grade 1 tear.
Grade 2: A moderate tear in which your MCL is partially torn — usually the superficial part of your MCL. Your knee will likely be loose when it’s moved by hand, and you’ll probably have intense pain and tenderness along the inner side of your knee.
Grade 3: A severe tear in which your MCL is completely torn — both the superficial and deep parts. Your knee will likely be very unstable and loose, and you’ll probably experience intense pain and tenderness. It’s common for someone to have other knee injuries, especially damage to their anterior cruciate ligament (ACL), if they have a grade 3 MCL tear.
MCL tears most often happen when the knee is hit directly on its outer side. They may also happen due to a sudden and forceful turning, twisting or “cutting.” This stretches the ligaments on the inside of the knee too far or can tear them. People who play certain sports like football, rugby, basketball, skiing and volleyball are more prone to MCL tears.
The following things may cause an MCL tear:
Planting one foot into the ground and forcefully shifting direction (this is known as “cutting” in sports).
When something or someone hits your knee on its outer side, such as from a football tackle.
Squatting or lifting heavy objects.
Landing awkwardly on your knee after a jump.
Hyperextending (overstretching) your knee. This is common in skiing.
Repeated pressure and stress to your knee, which causes your MCL to lose its elasticity.
Athletes may suffer tears of the MCL and anterior cruciate ligament (ACL) at the same time.
Popping sound at time of injury
Pain ranging from mild to severe
Stiffness and swelling
Tenderness along the inside of the knee
Feeling that the knee may “give way” under stress
Feeling that the knee will lock or catch
In most cases, a healthcare provider can tell if you have a torn MCL by doing a physical exam on your knee. If your provider thinks you may have an MCL tear, they'll bend your knee and apply pressure on it to see if your knee is loose. Your provider may have you undergo imaging tests to make sure you don’t have any other injuries in your knee and to see how severe your MCL tear is.
Your healthcare provider may use one or more of the following tests to diagnose an MCL tear:
Physical exam: Your provider will examine your knee to see if you have pain with palpation on the inside of your knee. They'll also apply pressure (stress) your MCL to see if it’s loose, which often means your MCL is torn.
MRI: An MRI (magnetic resonance imaging) uses a large magnet, radio waves and a computer to make detailed images of your organs and bones. An MRI is the imaging test of choice for MCL tears. It can help your provider see if you have any other soft tissue injuries in your knee.
Ultrasound: Ultrasound uses sound waves to take pictures inside your body. An ultrasound can help your provider see how severe your MCL tear is and if you have any other injuries in your knee.
X-ray: Your provider may take an X-ray of your knee to make sure you don’t have any broken bones or other injuries in your knee.
Most people who have an MCL tear recover from nonsurgical treatment. This is because your MCL has a good blood supply, which makes it easier for your tear to heal.
Nonsurgical treatment for an MCL tear can include:
Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.
Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.
Wearing a knee brace: Your provider may have you wear a knee brace that prevents your knee from moving side to side so that your MCL can heal.
Using crutches: Your provider may have you use crutches to walk so that you can limit the amount of weight you put on your affected knee.
Doing physical therapy: Your provider will most likely have you do physical therapy exercises to improve your strength and range of motion in your knee. Exercises may involve strengthening your thigh muscles, cycling and doing resistance exercises. If you have an MCL tear and play a sport, your healthcare team will tailor your physical therapy to the types of movements you do for the sport that you play.
A grade 1 MCL tear (minor tear) can usually heal on its own with rest within one to three weeks. Grade 2 and grade 3 MCL tears, which are more severe, need proper treatment in order to heal, which can include resting, wearing a knee brace and doing physical therapy. If you injure your knee, contact your healthcare provider as soon as possible.
Most MCL tears heal well without surgery. However, if you have other knee injuries alongside an MCL tear, you will likely need to undergo surgery. Professional athletes may need to consider surgery to fix their MCL tear to prevent future MCL issues when they return to their sport.
Click on the dropdowns below to learn about the various surgical procedures for MCL tears.
Arthroscopic Method
Most surgeons now favor reconstruction of the MCL using a piece of tendon or ligament to replace the torn MCL. This surgery is most often done with the aid of the arthroscope.
Arthroscopy is an operation that involves inserting a small fiber-optic TV camera into the knee joint, allowing the orthopedic surgeon to look at the structures inside the joint directly. Incisions are usually still required around the knee, but the surgery doesn't require the surgeon to open the joint. The arthroscope is used to view the inside of the knee joint as the surgeon performs the work.
Patellar Tendon Graft
One type of graft used to replace the torn MCL is the patellar tendon. This tendon connects the kneecap (patella) to the tibia. The surgeon removes a strip from the center of the ligament to use as a replacement for the torn MCL.
Hamstring Tendon Graft
Surgeons also commonly use a hamstring graft to reconstruct a torn MCL. This graft is taken from one of the hamstring tendons that attaches to the tibia just below the knee joint. The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the tibia. The graft used in MCL reconstruction is taken from the hamstring tendon that runs along the inside part of the thigh and knee. When arranged into three or four strips, the hamstring graft has nearly the same strength as a patellar tendon graft.
Allograft Reconstruction
Other materials are also used to replace the torn MCL. In some cases, an allograft is used. An allograft is tissue that comes from someone else. This tissue is harvested from tissue and organ donors at the time of death and sent to a tissue bank. The tissue is checked for any type of infection, sterilized, and stored in a freezer. When needed, the tissue is ordered by the surgeon and used to replace the torn MCL. The allograft (your surgeon's choice of graft) can be from the tibialis tendon, patellar tendon, hamstring tendon, or Achilles tendon.
Many surgeons use patellar tendon allograft tissue because the tendon comes with the original bone still attached on each end of the graft (from the patella and from the tibia). This makes it easier to fix the allograft in place.
The advantage of using an allograft is that the surgeon does not have to disturb or remove any of the normal tissue from your knee to use as a graft. The operation also usually takes less time because the graft does not need to be harvested from your knee.
Most doctors have their patients take part in formal physical therapy after MCL reconstruction. You will probably be involved in a progressive rehabilitation program for four to six months after surgery to ensure the best result from your MCL reconstruction.
At first, expect to see the physical therapist two to three times a week. If your surgery and rehabilitation go as planned during the first six weeks, you may only need to do a home program and see your therapist every few weeks over the four to six month period.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat MCL tears.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling. This helps prevent reinjury.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat MCL tears.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling. This helps prevent reinjury.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
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