Medial Collateral Ligament (MCL) Injuries in Children
About Knee Injuries
Knee injuries are common among active kids and teens, especially athletes. A torn medial security ligament (MCL)– a ligament that assists provide the knee its stability– is one of the more serious injuries.
Kids who tear their MCL tend to play contact sports, like football and soccer. More severe injuries occur when the beyond the knee is struck, causing it to unnaturally bend inward (toward the other knee). MCL tears can also occur when the lower leg twists or bends out too far. This produces tension on the MCL, a rope-like band, and it extends or breaks in half.
Children with a partially or entirely torn MCL may have swelling and pain in the first 24 hours of injury. Luckily, this injury can recover on its own from 1 to 6 weeks of resting the joint.
Most kids and teens will still have to undergo rehabilitation (” rehabilitation”) therapy to help regain strength in the joint.
Your child’s doctor can diagnose the injury with a physical exam that consists of special knee tests. They may perform additional tests such as x-rays and magnetic resonance imaging (MRI) to search for other injuries and to confirm the MCL injury.
What an MCL Does
The MCL is one of the 4 main ligaments in the knee joint. It’s located on the side of the knee that’s closer to the other knee. One end of the ligament is connected to the thigh, while the other end is attached to the tibia.
With the lateral collateral ligament (LCL), which remains in the same location on the exterior of the knee, the MCL assists avoid the knee joint from flexing too far from side-to-side.
Signs and Symptoms
A child with a partly or entirely torn MCL may or might not have symptoms, depending on the severity of the injury.
Pain and swelling can be intense at first, and some kids and teens with more severe injuries will have instability when walking, feeling “wobbly” or not able to bear weight on the afflicted leg.
Lots of kids and teens, particularly those who are familiar with the injury or have actually torn a ligament previously, report hearing a “pop” noise– the noise of the shinbone popping out of and back into the knee joint.
A child who has hurt a knee– whether on the field or at home– need to stop all activity, to prevent further injury, and seek instant treatment. In the meantime, keep the area iced– position the ice in a plastic bag, cover the bag in a cloth, and hold it to the knee for 20 minutes at a time. Likewise, keep the knee raised as much as possible to decrease swelling. As long as walking isn’t really painful, it’s OK to walk with an MCL tear. But if standing or walking causes any pain, don’t let your child put weight on the knee.
At the doctor’s workplace or emergency room, physicians will perform physical exams and imaging tests to figure out if there’s a knee injury and, if so, how severe it is.
To assist identify an MCL injury, physicians do a Valgus test. The child lies down flat, and the affected leg is moved out to the side, and the knee is bent about 30 degrees. The doctor places one hand on the back of the knee joint and the other on the top side of the ankle. The doctor then rotates the shin bone and pushes the foot outward, to see how far the MCL will extend. Too much flexibility can signify an injury.
To properly identify MCL injuries, physicians normally carry out these tests in combination or in addition to other physical examinations.
While X-rays might be taken to identify the level of the injury, they only look at bone and can only verify the existence of bone fractures in the knee. An MRI, which takes a look at soft tissue (like ligaments and muscles), can validate a partial or complete MCL tear, so some physicians will buy one to verify a diagnosis.
Types of Injuries
Doctors classify MCL injuries according to the following criteria:
- Grade I tear. This is a minor tear (or stretch) of the MCL. Both ends of the ligament are still attached to the bone, however part of the ligament might droop and be less tight. Recovery usually takes 1 to 2 weeks; therapy might not be needed.
- Grade II tear. This is a slightly more severe tear of the MCL, with part of the ligament sagging. Pain and swelling is normally more severe than with a grade I tear. Kids usually need 3 to 4 weeks of rest and often therapy.
- Grade III tear. With this type of injury, the MCL breaks in half. Kids and teens often can’t flex the knee or put weight on it without pain. They may be unstable while walking, and the knee may in some cases “provide.” Medical professionals may recommend a temporary knee brace for this injury as well as rehabilitation therapy for 6 weeks or longer.
Treatment of MCL injuries needs initial rest of the joint, in addition to icing, elevation, and compression plasters to assist reduce discomfort. It’s OK for your child to put weight on the knee as long as it’s not painful. Depending on the seriousness of the injury, doctors may advise crutches, limiting exercise, and a temporary knee brace. Putting too much pressure on the knee can cause reinjury. Non-prescription or prescription painkillers and anti-inflammatory medication can help kids and teens handle the pain and feel more comfy.
Physicians typically suggest rehabilitation therapy to help recover the knee and to:
- bring back range of motion
- gain back strength in the knee, thigh, and shin muscles (and prevent atrophy, the breakdown of muscle tissue)
- lower pain and swelling
- enhance balance
The majority of kids undergo rehabilitation at a center three times a week, with daily exercises they practice at home. Faster rehab programs include more frequent therapy, but that will not always speed recovery.
While many sports are off limits– especially the activity that triggered the injury– kids and teens can do low-impact activities that may be fun as well as healing, like swimming, bike riding, or protected running. Talk to your doctor about what activities might benefit your child.
Assisting Your Child Cope
Being told that you cannot do the things you like– like running or playing football, field hockey, or softball– can be a terrible blow to any child. Kids and teens recovering from an MCL injury, specifically a severe one, might feel upset, disappointed, and even depressed, specifically if they’re not participating in group sports with their buddies.
But in the meantime, there are ways to still seem like part of the group. Keeping rating, being a coach’s assistant, or bringing water to the games may assist. If your child does not want to do these things, suggest beginning a pastime, like playing the guitar, painting, drawing, or another activity that will not put too much strain on the knee. Low-impact activities, like swimming, are another choice.
In time, kids and teens can once again do the important things they love. But if your child continues to feel mad or depressed during recovery, motivate him or her to speak to a school psychologist or counselor, who can help your child cope and look ahead to better days.