1. Medial Collateral Ligament (MCL) Tear

2. Development of MCL Tear
A valgus force to the knee while bearing weight can put enough stress on the MCL to tear it
Since the deep part of the ligament is damaged first and this portion inserts into the medial meniscus, there can be concomitant injury here

3. Symptoms of MCL Tear
There are three grades with different symptoms and severity
Grade 1 symptoms (stretched ligament)
Mild Tenderness on the inside of the knee
No swelling need be present
Pain on Valgus stress test but no laxity
Grade 2 symptoms (partial thickness tear of the ligament)
Significant pain in the medial aspect of the knee
Moderate swelling present
Valgus stress test will indicate moderate instability
Grade 3 symptoms (full thickness tear, or complete tear)
Varied amounts of pain
Significant joint laxity on valgus stress test
Complaints of instability (“wobbly” or “unstable” complaints)
These injuries can also include tears to the ACL

4. Grades of Ligament Tears

5. Differential Diagnosis Tests
Valgus stress test
Palpation of the medial aspect of the knee from medial femoral condyle to the medial tibial plateau
Slocum’s modified anterior drawer test
Anterior drawer test with external rotation
These help differentiate from Pes Anserine Tendinopathy and Bursitis issues

6. Slocum’s Modified Anterior Drawer Test

7. Anterior Drawer Test with External Rotation

8. Recommendation
Time from injury, location, severity, and concomitant injuries will indicate need for surgery or if conservative treatment will be sufficient
Grade II injuries are treated initially with immobilization, R.I.C.E., and protected weight bearing
After swelling subsides then stretching, resistive exercise, and progressive weight bearing can be initiated
Grade I can begin second phase of grade II rehabilitation right away
Grade III tears require surgical intervention and referral to a doctor

9. Prognosis
Isolated grade I and II MCL tears respond well to conservative treatment and usually do not require surgical intervention
Most people in this group have no long term disability related to their injury
Grade III tears will require surgery for repair

10. References
Reider B. Medial collateral ligament injury in athletes. Sports Med. February 1996;21(2):
Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. June 2006;14(2):