Medical collateral ligament tear

l Classification
1. Classification system
Valgus laxity Quality of
Grade Examination findings Pathology
(at 30 of flexion) endpoint
1. Tenderness ove MCL with no instability
I 0 – 5 mm Firm endpoint Microscopic teat
2. MRI: Grossly intact ligament with periligamentous edema
Incomplete tear with
1. Increased valgus laxity with 5° – 15° of valgus instability
microscopic and
II 6 – 10 mm Firm endpoint 2. No rotatory instability or instability in extension
gross disturption of
3. MRI: Partial tear of the superficial MCL with surrounding edema
the sMCL fibers
1. Significant valgus laxity with more than 15° of instability to valgus stress
No eppreciable Complete rupture of
III > 10 mmm 2. There may also be rotatory instability in extension
endpoint the MCL complex
3. MRI: Full-thickness tear of the sMCL and periligamentous edema
ü The most common pattern of combined injury involves the MCL and ACL, comprising 7-8% of all ligamentous knee injuries.
ü The most worrisome is a multiligamentous injury involving the MCL plus two or three additional ligaments (ACL, PCL, and LCL in any
combination), often associated with a history of knee dislocation.

2. Recovery
Functional recovery Structural recovery
Grade I 7 – 21 days 6 weeks
Grade II 2 – 8 weeks 1 – 3 months
Grade III 3 months 6 – 12+ months
l Non-operative management of knee ligament injuries
Key examination Goals Intervention
Maximum ¨ Pain scale ¨ Protect healing tissues ¨ PRICE
protection phase ¨ Joint effuction ¨ Prevent reflex inhibition of ¨ Ambulation training with crutches (WB as tolerated)
¨ Ligament stability muscle ¨ PROM / AAROM
¨ ROM ¨ Decrease joint effuction ¨ Patellar mobilization (grade I/II)
¨ Muscle control ¨ Decrease pain ¨ Muscle setting (quadriceps, hamstrings, and adductors)
¨ Functional status ¨ SLRs
¨ Patellar mobility ¨ Aerobic conditioning
Moderate ¨ Pain scale ¨ Full, pain-free ROM ¨ Multiple angle isometric
protection phase ¨ Joint effuction controlled ¨ Restore muscular strength ¨ Initiate PRE
¨ No increased instability ¨ Gait w/o assistive decive ¨ Closed-chain strengthening
¨ Full or nearly full ROM ¨ Normalize ADL functiom ¨ LE flexibility exercise
¨ Endurance training (bike, pool)
¨ Perturbation/balance training
¨ Stabilization exercise
¨ Initiate a walk/jog program at the endof this phase
¨ Initiate skill-specific drills at the end of this phase
Minimum ¨ Ligament stability ¨ Increase strength / power / ¨ LE flexibility
protection phase ¨ Muscle control endurance ¨ Advance strengthening / closed-chain training / perturbation
¨ Functional status ¨ Improve neuromuscular training / endurance training
control ¨ Isokinetic training
¨ Improve dynamic stability ¨ Progress running program, full speed jog, sprints, figure-right
¨ Functional ability return running, and cutting
¨ Implement drills specific to sport for occupation
¨ Determine need for protective bracing prior to return sport or work
l Reference
1. Kisner, C. and Colby, L.A. (2018) Therapeutic Exercise: Foundations and Techniques. F.A. Davis Company, Philadelphia.
2. Phisitkul, P., James, S. L. (2006). MCL injuries of the knee: current concepts review. The Iowa orthopaedic journal, 26, 77–90.