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Medial Collateral Ligament Sprains A Case Study

Eric Smoyer Nebraska Wesleyan University


Not just one bundle but two

Superficial Deep (Medial Meniscus)

Originates Medial Epicondyle of Femur Inserts

Prevent Valgus Force Stabilize Medial Knee

Superficial to medial side of tibia Deep to tibial plateau and medial meniscus

Anatomy Contd
In full Ext. both prevent hyperextension Always has tension to prevent medial tibial translation. Helps limit external rotation of tibia Actually only protects from valgus forces in slight flexion

MCL Injury
Very common in contact sports Foot planted, Knee flexed, and valgus force applied, sometimes rotation No medical predisposition

Case Report
20 year old Caucasian Male Football player During Regular Season game

Case Report History

Healthy and Acclimated physical state No previous injury reported Reported valgus force while knee flexed and foot planted Heard a snap in his knee Sharp pain that quickly became a dull ache on Medial Knee

Case Report Evaluation

PPT over MCL both Superior and Inferior Positive Test Negative Tests
Valgus Stress at 30 degrees Valgus Stress at zero degrees Varus both zero and 30 Lachman's Anterior/Posterior Drawer Posterior Sag Pivot/Shift McMurrays

Case Report Assessment

Grade II MCL Sprain MRI Doctor also concluded Grade II-III MCL Spain Doctor also did not see any damage to other ligaments

Case Report - Treatment

First Reduce Swelling and Pain

Interferential Stimulation High Volt Ice

Approx. 10 Days post injury

Passive ROM exercises performed Active ROM Reduce stiffness and restore ROM

Once ROM was met Bike was used

Case Report - Treatment

Three weeks post injury

Muscle Strengthening Exercises
Knee Ext/Flex Hip Ext/Flex Add/Abd Lower Leg Inv/Ev Plant/Dorsi Single and Double Leg raises

Case Report - Treatment

Once Strength and Reduced Pain Achieved

One legged balance exercises
Flat Ground AirEx Pad BOSU

Four to Five Weeks Post Injury

Functional Testing DonJoy MCL Brace
Running Running Stopping Cutting Side Strides Carioca

Case Report - Treatment

Six Weeks post injury

Athlete was cleared by doctor Full Contact Return to play MCL Brace

Case Report Outcome

Approximately six weeks Competed in rest of regular season MCL Brace No further complaints

Dull Pain Continued to ice for mild swelling


When injured there are many options

Rehabilitation Repair

In the past usually used surgery Today Non-invasive treatment is best choice Non-operative has yielded excellent results Grade III

Surgery best option

Discussion - Research
Rat study Three Groups

Rats with surgery and no MCL rupture Rats with surgery MCL rupture ambulated Rats with surgery MCL rupture and non weight bearing

Two Sub-Groups
Rats with three weeks to heal Rats with seven weeks to heal

Discussion - Research

Discussion - Research
Control no difference Ambulated showed most improvement Non-Weight showed very little Shows importance of slight weight-bearing in the realignment of collagen fibers Realignment means more strength

Discussion - Research
Surgery has a lot of controversy The MCL has been found to heal better than once thought Leads to MCL injuries to be treated more conservatively Surgery is recommended when:

Instability with excessive medial joint opening Instability with no firm endpoint on valgus stress test

Discussion - Research
When surgery is recommended there are many ways A new way uses parts of the Gracilis and Semitendinosus

Grafted together Secured at same origin and insertion Utilizes smaller incisions

The study showed after several months

88% graded normal on instability tests Pre-Surgery avg. medial joint opening was 3-6mm Post-Surgery avg. medial joint opening was <2mm

Only replaces superficial portion but still improves stability

Discussion - Research



After injury most likely to wear brace Used since the inception of football Huge debate on effectiveness Cadaver Models

Tests showed small increase in strength about 30% May hinder athletic performance

Few studies done, still inconclusive

One study showed a slight decrease in high speed running

Several Factors
Tightness Contours Weight Overall Comfort

Effectiveness based on placement Tests still inconclusive


Athlete in study did what was best for him Differs with athlete and degree of injury Further complications Study showed weight bearing is an important role in restoring ligament strength Braces may help increase resistance to valgus forces but still inconclusive MCL can be easily damaged but today can be rehabilitated more quickly


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