Last post we discussed ACL injuries, the granddaddy of knee pain. Equally common are medial collateral ligament (MCL) injuries. The MCL crosses the inside of the knee, and provides stability to prevent valgus stress, the stress that would occur to the knee if you were to push one knee in towards the other from the outside, and also contributes to rotational stability. Forceful movement into valgus or rotation can cause ligament failure, and, unlike the ACL, we have more variety in the degree of damage that may occur. We grade MCL injuries from 1 (fiber disruption but minimal loss of stability) to 3 (full rupture/gross instability). Pain and swelling will be more isolated to the inside aspect of the knee. Because the MCL has several different attachments, the grade of injury reported on a scan must always be correlated with clinical exam as the degree of instability may differ, as will the management.
Grade 1 injuries are initially managed by relative rest settle the pain, while maintaining strength and mobility in unaffected joints. Once pain settles, direct loading to the knee may be progressed as tolerated. While instability is less of an issue, grade 1s can be even more painful than more severe injuries, and it is often the pain that limits progression.
Depending on the location, grade 2 injuries usually need a hinged brace to support the knee and promote healing. This is usually kept on for 4-6 weeks and initially involves a period of non-weight bearing. Aside from the bracing protocol and range of motion restrictions, grade 2 rehab is similar to grade 1. Both degrees of injury typically require 6-8 weeks to return to skiing, although slower healing times may necessitate prolonged return to sport.
Grade 3s will be braced in a similar way to a grade 2, but the time will be longer, and patients can expect a 10-12 week recovery time. Unlike ACL injuries, depending on the stage of the season, a within-season return may be possible. If you have suffered a knee injury on the slopes then contact us now and let us help guide you on the path to recovery.
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