Medial Collateral and Lateral Collateral Ligament Injury Treatment & Management
- Author: Adam B Agranoff, MD; Chief Editor: Consuelo T Lorenzo, MD more...
The type of physical therapy (PT) treatment indicated for a medial collateral ligament (MCL) injury depends on the severity of the injury.[7, 14] Recommendations for treatment include the following:
- Grade I - Compression, elevation, and cryotherapy are recommended. Short-term use of crutches may be indicated, with weight-bearing–as–tolerated (WBAT) ambulation. Early ambulation is recommended.
- Grade II - A short-hinged brace that blocks 20º of terminal extension but allows full flexion should be used. The patient may ambulate, WBAT. Closed-chain exercises allow for strengthening of knee musculature without putting stress on the ligaments.
- Grade III - The patient initially should be non–weight-bearing (NWB) on the affected lower extremity. A hinged braced should be used, with gradual progression to full weight-bearing (FWB) over 4 weeks. Grade III injuries may require 8-12 weeks to heal.
All MCL injuries should be treated with early range of motion (ROM) and strengthening of musculature that stabilizes the knee joint. Conservative measures usually are adequate, but, if the patient fails to progress with treatment, a meniscal or cruciate ligament tear is suggested.
Lateral collateral ligament (LCL) injuries heal more slowly than do MCL injuries, due to the difference in collagen density. Recommendations for the treatment of LCL injuries include the following:
- Grades I and II - These injuries are treated according to a regimen similar to that for MCL injuries of the same severity. A hinged brace is used for 4-6 weeks.
- Grade III - Severe LCL injuries typically are treated surgically due to rotational instability, because they usually involve the posterolateral corner of the knee. Patients may require bracing and physical therapy for up to 3 months in order to prevent later instability.
Most patients with a collateral ligament injury can be treated effectively with conservative measures. Grade III lateral collateral ligament (LCL) tears usually involve the posterolateral complex and are associated with instability. These patients do require surgical repair.[15, 16, 17, 18, 19] Surgical treatment for isolated injuries of the medial collateral ligament (MCL) or LCL is a controversial topic. The treatment plan should be based partially on the patient's pre-injury level of activity and on motivational factors. For example, a young competitive swimmer may want surgery, followed by a comprehensive rehabilitation program to accelerate the time needed for adequate functional recovery. A technique for repairing severe MCL injuries using autogenous hamstring tendons has been proposed.
A study by Dong et al indicated that both anatomic ligament repair and triangular ligament reconstruction are about equally effective in the treatment of acute grade III MCL tear combined with anterior cruciate ligament (ACL) tear. The study, which involved 64 patients, had a mean 34-month follow-up period. Although International Knee Documentation Committee (IKDC) scores and evaluation of the medial opening of the knee showed no significant differences between the techniques, the investigators did find that patients who underwent triangular ligament reconstruction had a significantly lower incidence of anteromedial rotatory instability than did the anatomic ligament repair patients at final follow-up.
An orthopedic surgery consultation is advised for individuals with severe ligament injury.
Fu FH, Harner CD, Johnson DL, et al. Biomechanics of knee ligaments: basic concepts and clinical application. Instr Course Lect. 1994. 43:137-48. [Medline].
Swenson TM, Harner CD. Knee ligament and meniscal injuries. Current concepts. Orthop Clin North Am. 1995 Jul. 26(3):529-46. [Medline].
Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996. 783-812.
Amiri S, Cooke D, Kim IY, et al. Mechanics of the passive knee joint. Part 2: interaction between the ligaments and the articular surfaces in guiding the joint motion. Proc Inst Mech Eng [H]. 2007 Nov. 221(8):821-32. [Medline].
National Collegiate Athletic Association. NCAA Injury Surveillance System. 1999-2000. [Full Text].
Yawn BP, Amadio P, Harmsen WS, et al. Isolated acute knee injuries in the general population. J Trauma. 2000 Apr. 48(4):716-23. [Medline].
Quarles JD, Hosey RG. Medial and lateral collateral injuries: prognosis and treatment. Prim Care. 2004 Dec. 31(4):957-75, ix. [Medline].
Dugan SA. Sports-related knee injuries in female athletes: what gives?. Am J Phys Med Rehabil. 2005 Feb. 84(2):122-30. [Medline].
El-Dieb A, Yu JS, Huang GS, et al. Pathologic conditions of the ligaments and tendons of the knee. Radiol Clin North Am. 2002 Sep. 40(5):1061-79. [Medline].
Pimentel L. Orthopedic trauma: office management of major joint injury. Med Clin North Am. 2006 Mar. 90(2):355-82. [Medline].
Strayer RJ, Lang ES. Evidence-based emergency medicine/systematic review abstract. Does this patient have a torn meniscus or ligament of the knee?. Ann Emerg Med. 2006 May. 47(5):499-501. [Medline].
Crotty JM, Monu JU, Pope TL Jr. Magnetic resonance imaging of the musculoskeletal system. Part 4. The knee. Clin Orthop Relat Res. 1996 Sep. 288-303. [Medline].
Beall DP, Googe JD, Moss JT, et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Radiol Clin North Am. 2007 Nov. 45(6):983-1002, vi. [Medline].
Hastings DE. The non-operative management of collateral ligament injuries of the knee joint. Clin Orthop. 1980 Mar-Apr. (147):22-8. [Medline].
Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. 2007 Oct. 23(10):1066-72. [Medline].
Wahl CJ, Nicandri G. Single-Achilles allograft posterior cruciate ligament and medial collateral ligament reconstruction: a technique to avoid osseous tunnel intersection, improve construct stiffness, and save on allograft utilization. Arthroscopy. 2008 Apr. 24(4):486-9. [Medline].
Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res. 2012 Mar. 470(3):798-805. [Medline]. [Full Text].
Schein A, Matcuk G, Patel D, Gottsegen CJ, Hartshorn T, Forrester D, et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol. 2012 Dec. 19(6):489-98. [Medline].
Medvecky MJ, Zazulak BT, Hewett TE. A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete. Sports Med. 2007. 37(2):169-87. [Medline].
Yoshiya S, Kuroda R, Mizuno K, et al. Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med. 2005 Sep. 33(9):1380-5. [Medline].
Dong J, Wang XF, Men X, et al. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy. 2015 Jun. 31 (6):1108-16. [Medline].