Medial collateral ligament (MCL) injury

• Grade 1 few fibers of the MCL are torn. This is mild grade and often referred to as a sprain to the ligament in the MRI report.
• Grade 2 is moderate injury, where partial tear means many fibers are torn, but continuity is maintained.
• Grade 3 is the most severe type in which there is complete rupture or tear of the ligament and continuity is absent.

• Pain in the inner part of the knee joint
• Swelling of the knee joint
• Instability/ difficulty in maintaining the balance of knee joint
• Not able to keep balance climbing up or down stairs
• Not able to play sports, do gym, dance and do daily activities

MCL injury is diagnosed by physical examination, x-rays and MRI.

In most cases of grade 1 and grade 2, tear of MCL

• Ice packing
• Pain killers
• Knee braces
• Physiotherapy

The patient can resume his duties in concern with treating the surgeon. Results are usually very good, and patients will be fully functional after treatment within 3-6 weeks.

In grade 3 injuries, in cases where there is complete avulsion from the shin bone, or there is bone fracture, surgery is required, if any other ligament is injured with MCL, including ACL, PCL. Chronic/long-duration tear with significantly less tissue to repair.

The best surgical treatment for MCL injury is MCL reconstruction surgery. It involves using a graft from the patient body and placing it in a position where there was original MCL.

• Proper positioning of the graft is of utmost importance. Most cases of reinjury or failure of reconstructions occur due to wrong or misplaced positions of tunnels inside the femur or tibia bone. A good surgeon always focuses on making the tunnel accurate, as difference in position (in millimetres) can cause increased failure rates.
• Ligament is secured in place with the help of fixation devices.

Fixation devices used in MCL reconstruction are screws and buttons.

Screws used in MCL reconstruction surgery can be bioabsorbable or hydroxyapatite coated.

• Bioabsorbable screws dissolve inside the bone. These screws are usually absorbed within 2 years and don't cause inflammation, clinical problems, or reactions.But further studies are required to know about detailed properties.
• Hydroxyapatite-coated screws

Hydroxyapatite is naturally present in the bone and teeth of humans up to 50% volume and 70% weight.

•  Screws coated with hydroxyapatite naturally tend to fix bone.
•  They also help in increased bone formation and better healing.
•  Reduces infection risk
•  Less chances of allergies or other sensitivities
•  Better for x-ray and other imaging as they are radiopaque hence better visibility.

The ultimate decision of choosing between types of screws should be taken in consultation with the surgeon.

This technique is used only if sufficient MCL is present, which can be repaired. In cases where a long time has occurred and very little tissue is present to improve this technique is not possible. This is one of the new techniques which is in use. This technique involves

• MCL repair instead of MCL reconstruction; no graft is taken, and the original MCL is repaired.
• Fiber tape is used to provide strength to repaired MCL.

Although it provides better functional outcomes, few studies support the current concept. Many studies have concluded no difference between MCL reconstruction and MCL repair with the internal brace technique. Detailed studies are further required to provide depth knowledge.

The patient usually has to wear the brace for 6 weeks post MCL reconstruction, and till then, he has to use crutches or walkers to walk after that patient can put weight on his leg.

Usually, it takes 6 months for a full recovery and returns to heavy duty or sporting activities.

Usually, it depends on the patient's medical condition; if the patient is not suffering from any disease before surgery, hospital stay is for 2-3 days.

You can shower within 2-3 days after MCL reconstruction surgery. Usually, waterproof dressing is applied to the wound, after which the patient can shower. But to take a bath or swim, the patient will require 4-6 weeks. The patient has to keep the wound dry and avoid using hot water as it increases swelling.

It depends on the hospital category chosen by patients and the type of implant which is discussed.

At Simpainortho.com, we have tried to reduce the cost of surgery and hospital expenses and included complete after-surgery services, which patients require after surgery because we know treatment doesn't end at the patient's discharge. To ensure the quick recovery of patients in simpainortho.com, we believe that a patient requires expert care within the most comfortable surrounding him until he can join routine activities. So, we have made different packages for different patients according to need, and that too at the most affordable prices.

Yes, most insurances have included MCL reconstruction surgery.