MEDIAL COLLATERAL INJURY LIGAMENT

Medial collateral ligament is important contributor of medial stabilisers. It gives stability against the valgus overload.
MCL is very important. It is often injured due to sports injury, vehicular accidents or falls. MCL can be injured by forced abduction and forced external rotation.
During acute episode,
There is buckling or giving away of knee. Often, pop is felt. There is severe pain and difficulty in walking.
After the acute episode ,
Patient may complain of giving away.
Signs
There is quadriceps wasting, due to disuse. Flexion attitude is due to hamstring spasm. Localised tender spot is felt medially. Incomplete extension is a common feature of internal derangement of knee.

Abduction (Valgus stress test)
Knee is flexed at 30 degrees. Stabilise thigh and abduct leg. Look for pain and opening up. Grade of opening up denotes, the grade of instability.

Appley’s compression distraction test
Patient lies prone. Knee is flexed at ninety degrees. Thigh is stabilised and foot is grasped. Traction is given on foot. Pain suggests injury to ligamentous complex. In second step, compressive force is given. Simultaneously foot is rotated. Pain suggests meniscal injury.


Management
Initial management of acute injuries is with RICE.

R rest
I immobilisation
C cryotherapy
E elevation

First Degree sprains usually respond to extended first line regime.
Second Degree sprains require protection in cast or with hinged braces. Lateral hinged brace ( for 6 weeks) are prescribed for valgus instability. Mobilisation exercises area given after 6 weeks.
Third Degree sprains can be treated conservatively.
Primary repair is indicated in following circumstances.
a. Isolated tears with severe instability
b. Avulsion fracture
c. Associated meniscal or cruciate injuries

Secondary repair
By definition, chronic injuries refer to instabilities that still exist 3 months after acute episode. Secondary repair or reconstruction is done for chronic instability. Elongated slack ligament is common cause of instability. It is very important to strengthen stabilizers like quadriceps and hamstrings.
Reconstructive procedures can be done by
a. Reattachment
b. Advancement or plication
c. Reinforcement by
1) Static stabilizers: fascia, tendons: Pes anserinus
2) Dynamic: Muscle: sartorius


Every repair or reconstruction should be followed by physiotherapy protocol.
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