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Knee

MCL and PMC Injury Treatment Options

Medial Collateral Ligament (MCL) injuries are among the most common knee injuries, especially for those involved in activities that put stress on the knees. The MCL, which runs along the inner side of the knee, helps stabilize and support knee movement. MCL injuries can vary in severity, from minor sprains to complete tears. Understanding the types of MCL injuries and the best treatment options can help guide recovery and promote optimal healing.

The treatment approach for an MCL injury depends on its severity. Fortunately, the MCL has a robust blood supply, allowing it to heal effectively in many cases. Treatments can range from conservative care to surgical intervention.

For most MCL injuries, non-surgical treatment is effective and preferred. This approach focuses on reducing pain, controlling swelling, and promoting healing. The initial treatment plan for an MCL tear may include:

  • Ice Application: Applying ice packs to the injured area helps reduce swelling and alleviate pain.
  • Elevation: Elevating the knee helps minimize swelling by promoting fluid drainage.
  • Immobilization: Using a knee brace or splint to limit knee movement aids in protecting the ligament during the early stages of healing.
  • NSAIDs: Nonsteroidal anti-inflammatory drugs can help manage pain and reduce inflammation.
  • Compression: Wrapping the knee with an elastic bandage provides support and reduces swelling.
  • Crutches: These are used to limit weight-bearing and allow the knee to rest.
  • Rest: Essential for recovery, resting prevents further stress on the injured ligament.

Immediate care is crucial during the first 72 hours post-injury. For Grade 1 and some Grade 2 MCL injuries, this conservative treatment may suffice to kickstart recovery.

Physical therapy is a vital component of the treatment plan, aimed at restoring knee strength, range of motion, and preventing future injuries. A typical MCL rehabilitation program may include:

  • Strengthening Exercises: Targeting the muscles around the knee, such as the quadriceps and hamstrings, enhances stability and function.
  • Range of Motion Exercises: These exercises help maintain or improve flexibility in the knee joint.
  • Protective Bracing: Wearing a knee brace during physical activities provides additional support as the ligament heals.
  • Activity Modification: Limiting activities, particularly high-impact or contact sports, ensures the knee is not subjected to undue stress.

Recovery timelines for MCL injuries can vary based on the severity. Grade 1 injuries may heal within one to two weeks, while Grade 2 injuries may take up to eight weeks.

Surgery is rarely the first choice for MCL injuries but becomes necessary when:

  • The MCL is torn in such a way that natural healing is unlikely.
  • The injury is accompanied by damage to other knee ligaments, such as the ACL or PCL.
  • Non-surgical treatments have failed to provide adequate healing or stability.

Before undergoing surgery, Cinque often recommends an arthroscopic evaluation to fully assess the extent of the MCL tear and any associated injuries. Arthroscopy is a minimally invasive procedure involving the insertion of a small camera through a tiny incision to examine and sometimes treat the knee. This allows for a precise understanding of the injury’s scope.

For MCL reconstruction, the surgeon makes an incision along the inner side of the knee. Depending on the location and nature of the tear, different techniques may be used to reattach the ligament to the shinbone or thighbone. These methods include:

  • Large Stitches: Sutures that securely anchor the torn ligament back to its attachment site.
  • Bone Staples: Metallic staples that affix the ligament to the bone.
  • Metal Screws: Screws used to secure the ligament into place.
  • Suture Anchors: Specialized devices that anchor the ligament and provide stability during the healing process.

Recovery from MCL reconstructive surgery involves a carefully structured rehabilitation program. Physical therapy begins on the first day post-surgery, focusing on maintaining range of motion while protecting the repair. Key recovery milestones include:

  • First 6 Weeks: Limited or non-weight-bearing activities, with the use of crutches and a brace to support the knee.
  • 6-8 Weeks: Transition to partial weight-bearing as tolerated. Patients may wean off crutches when they can walk without a limp.
  • 8+ Weeks: Continued physical therapy to build strength and flexibility, with an emphasis on endurance and agility training. Full participation in physical activities, including sports, is generally possible around 6-12 months post-surgery, depending on individual progress.

MCL tears, while common, are highly treatable with the right approach. Whether through conservative management or surgical intervention, the focus is on restoring knee function and stability. Cinque’s expertise in MCL treatment ensures that patients receive tailored care, facilitating the best possible recovery and return to activity.

Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.

At a Glance

Mark Cinque, MD

  • Board-certified, fellowship-trained orthopedic surgeon
  • Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
  • Authored over 100 peer-reviewed publications
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