Knee - MCL Injuries
Description
The medial collateral ligament (MCL) is the main stabilizing ligament on the inner aspect of the knee. Its main function is to prevent the knee from buckling inward/knock-knee (valgus motion). Tears/ruptures of the ligament results in knee instability.
What are the causes?
MCL tears are typically caused by trauma. A direct force to the outside of the knee stresses the ligament. This typically occurs in collision sports like football. Overuse injuries in sports/occupations that require repetitive falling to the knees and standing up quickly can also lead to micro tears of the ligament.
What are the symptoms?
MCL tears cause immediate pain and often swelling. You may feel something “pop” on the inside aspect of the knee. Pain is centralized over the ligament (inside aspect of the knee). Walking after the injury may be possible but the knee may feel like it’s going to “give in” depending on the severity of the tear. The MCL is attached to the underlying meniscus. Damage to the meniscus at the time of injury may cause clicking or locking of the knee.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength is present. Your surgeon will perform maneuvers to check stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the MCL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in treatment planning. The MRI may also show bone bruising secondary to the injury.
Non-operative
Almost all minor MCL tears can be treated non-operatively. Non-operative treatment consisting of bracing, anti-inflammatory medication, physical therapy, cryotherapy and activity modification may be prescribed to decrease the swelling, regain motion and strength. Most patients may be able to return to normal activity without surgery depending on the type and severity of the tear. A brace may be prescribed to return to sports activities. If symptoms persist (pain, instability), reconstruction surgery may be recommended by your surgeon.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. 1 injection may be all you need, however, there are times where multiple injections may be provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the tendon. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Operative management of MCL tears depends on the type of tear. MCL repair may be indicated in patients where the MCL is clearly torn off the wall of the femur (thigh bone) or tibia (shin bone. MCL repair is accomplished through a series of small incisions and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture.
If formal reconstruction is required, a new MCL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most techniques are performed through a minimally-invasive incision. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.
Coming Soon!
Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.