1. REHABILITATION OF MEDIAL COLLATERAL LIGAMENT Dr. Ali Abd El-Monsif Thabet

2. Medial Collateral Ligament  The medial collateral ligament (MCL) is a thick band extending from medial femoral epicondyle down to the medial surface of the upper tibia 7-10 cm below the joint-line

5. Kinematics  The MCL, specifically the superficial portion, is the primary restraint to excessive abduction (valgus)  At close to full extension, the MCL accounted for 57% of the restraining force against valgus opening.  The MCL has the capacity to heal when ruptured or damaged, because of its rich blood supply.

7. Pathomechanics  The MCL is the most commonly injured ligament in the knee.

8. Injury Mechanism  Clip injury the typical mechanism of a clip injury resulting from a valgus force to the lateral aspect of the knee.

10. Injury Mechanism  A common triad of injury (particularly in athletes) when a valgus force is applied to the knee involves injury to the MCL, the medial meniscus, and the anterior cruciate ligament.

12. Grades  Grade 1 symptoms:  Mild tenderness on the inside of the knee over the ligament.  Usually no swelling.

13.  Grade 2 symptoms:  Significant tenderness on the inside of the knee on the medial ligament.  Some swelling seen over the ligament.

14.  Grade 3 symptoms:  This is a complete tear of the ligament.  Pain can vary and is sometimes not as bad as that of a grade 2 sprain.

15. Valgus stress testing of the MCL

18. Rehabilitation of MCL injury  Goals:  1) Resolve pain and swelling  2) Gain full ROM  3) Improve muscular strength and endurance  4) Normalize gait pattern without assistive device  5) Return to sports activities. Functional brace may be warranted to provide medial and lateral knee support.

19.  Grade 1 Sprain:  The rehabilitation guidelines for a grade 1 or mild medial ligament sprain can be split into 4 phases:

20.  Grade 2 or 3 Sprain:  For a grade 2 and particularly 3 sprain it is important that the ends of the ligament are protected and left to heal without continually being disrupted. The rehabilitation guidelines for a grade 2 or 3 medial ligament sprain (more severe) can be split into 4 phases:

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