MCL Tear

What is an MCL (medial collateral ligament) tear?

An MCL tear is damage to the medial collateral ligament, which is a major ligament that’s located on the inner side of your knee. The tear can be partial (some fibers in the ligament are torn) or complete (the ligament is torn into two pieces). A ligament is a tough band of tissue that connects one bone to another bone or holds organs in place.

What is the medial collateral ligament (MCL)?

Your knees are made up of bones, ligaments, tendons and cartilage. The medial collateral ligament (MCL) is located on the inner side of your knee, and it’s eight to 10 centimeters in length. It connects your thigh bone (femur) to your shin bone (tibia). Your MCL also provides strength and stability to your knee joint. It’s one of four primary ligaments in your knee. The other three primary ligaments include:

• The anterior cruciate ligament (ACL).
• The lateral collateral ligament (LCL).
• The posterior cruciate ligament (PCL).

The word “medial” means “towards the middle or center.” When referring to ligaments, “collateral” means that the ligament is on one side of a joint. The medial collateral ligament is named such because the ligament is on the inner side of your knee (closer to the “middle line” of your body), and it’s located on the side of your knee joint.

Are there different types of MCL tears?

Your healthcare provider will describe your MCL tear as one of the following three grades:

• Grade 1: A grade 1 MCL tear is a mild tear in which less than 10% of fibers in your ligament are torn and your knee is still stable. You’ll likely have some tenderness and mild pain if you have a grade 1 tear.
• Grade 2: A grade 2 MCL tear is a moderate tear in which your MCL is partially torn — usually the superficial part of your MCL. Your knee will likely be loose when it’s moved by hand, and you’ll probably have intense pain and tenderness along the inner side of your knee.
• Grade 3: A grade 3 MCL tear is a severe tear in which your MCL is completely torn — both the superficial and deep parts. Your knee will likely be very unstable and loose, and you’ll probably experience intense pain and tenderness. It’s common for someone to have other knee injuries, especially damage to their anterior cruciate ligament (ACL), if they have a grade 3 MCL tear.

Who gets MCL tears?

Anyone can experience an MCL tear at any age. MCL tears are a common injury for athletes, especially those who play sports like football, rugby, basketball and skiing.

How common are MCL tears?

MCL tears are fairly common. MCL tears are the most common knee ligament injury, and approximately 40% of all knee injuries involve the MCL.

What are the symptoms of an MCL tear?

The symptoms of an MCL tear can vary based on how severe your tear is. If your MCL (medial collateral ligament) is torn, you may experience the following signs and symptoms:

• Hearing a popping sound at the time of the injury.
• Experiencing pain in your knee.
• Having tenderness along the inner side of your knee.
• Having stiffness and swelling in your knee.
• Feeling like your knee is going to “give out” if you put weight on it.
• Feeling your knee joint lock or catch when you use it.

Can you still walk with a torn MCL?

If you have a grade 1 (minor) MCL tear, you'll likely still be able to walk at the time of the injury, though it might be painful. A grade 2 (moderate) MCL tear could make it difficult to walk at the time of the injury since your knee won’t be as stable as it normally is. If you have a grade 3 (severe) MCL tear, it’ll be difficult to walk since your knee will be unstable, and you probably won’t want to walk since it’ll be very painful. In most cases, treatment for MCL tears involves using crutches to limit the amount of weight you put on your affected knee.

If you injure your knee, it’s important to contact your healthcare provider immediately or go to the nearest hospital, even if you can still walk on it.

What causes an MCL tear?

Sudden and forceful turning, twisting and “cutting” can cause MCL tears. A direct blow to the outer side of your knee can also cause an MCL tear. MCL tears are most common in people who play certain sports like skiing, football, basketball and volleyball.

The following situations can cause an MCL tear:

• Planting one foot into the ground and forcefully shifting direction (this is known as “cutting” in sports).
• When something or someone hits your knee on its outer side, such as from a football tackle.
• Squatting or lifting heavy objects.
• Landing awkwardly on your knee after a jump.
• Hyperextending (overstretching) your knee. This is common in skiing.
• Repeated pressure and stress to your knee, which causes your MCL to lose its elasticity (like a worn-out rubber band).

How is an MCL tear diagnosed?

In most cases, a healthcare provider can tell if you have a torn MCL by doing a physical exam on your knee. If your provider thinks you may have an MCL tear, they'll bend your knee and apply pressure on it to see if your knee is loose. Your provider may have you undergo imaging tests to make sure you don’t have any other injuries in your knee and to see how severe your MCL tear is.

What tests will be done to diagnose an MCL tear?

Your healthcare provider may use one or more of the following tests to diagnose an MCL tear:

• Physical exam: Your provider will examine your knee to see if you have pain with palpation on the inside of your knee. They'll also apply pressure (stress) your MCL to see if it’s loose, which often means your MCL is torn.
• MRI: An MRI (magnetic resonance imaging) uses a large magnet, radio waves and a computer to make detailed images of your organs and bones. An MRI is the imaging test of choice for MCL tears. It can help your provider see if you have any other soft tissue injuries in your knee.
• Ultrasound: Ultrasound uses sound waves to take pictures inside your body. An ultrasound can help your provider see how severe your MCL tear is and if you have any other injuries in your knee.
• X-ray: Your provider may take an X-ray of your knee to make sure you don’t have any broken bones or other injuries in your knee.

How is an MCL tear treated?

Most people who have an MCL tear recover from non-surgical treatment. This is because your MCL has a good blood supply, which makes it easier for your tear to heal. Non-surgical treatment for an MCL tear can include:

• Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. The RICE method helps reduce pain and swelling.
• Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee.
• Wearing a knee brace: Your provider may have you wear a knee brace that prevents your knee from moving side to side so that your MCL can heal.
• Using crutches: Your provider may have you use crutches to walk so that you can limit the amount of weight you put on your affected knee.
• Doing physical therapy: Your provider will most likely have you do physical therapy exercises to improve your strength and range of motion in your knee. Exercises may involve strengthening your thigh muscles, cycling and doing resistance exercises. If you have an MCL tear and play a sport, your healthcare team will tailor your physical therapy to the types of movements you do for the sport that you play.

While non-surgical treatment is very effective in treating MCL tears, professional athletes may want to consider undergoing surgery to fix their tear due to the amount of stress and pressure they’ll have on their knee when they return to their sport. If you have an MCL tear and other knee injuries at the same time, you’ll likely have to undergo surgery to fix your injuries.

If you need to have surgery for your MCL tear, your surgeon will either reattach the torn part of your MCL or reconstruct and/or augment your MCL using a graft. An MCL graft can be constructed with a piece of tissue from elsewhere in your body, such as your hamstring tendons, or from a donor. Your surgeon will likely use small incisions (cuts) on your inner knee to perform your MCL surgery.

Recovery time from MCL surgery depends on a few factors, including:

• The severity of your MCL tear.
• The type of surgery you had.
• If you also had surgery on other parts of your knee.
• Your age and overall health.

MCL surgery recovery often involves physical therapy to increase your strength and the range of motion in your knee.

Can an MCL tear heal on its own?

A grade 1 MCL tear (minor tear) can usually heal on its own with rest within one to three weeks. Grade 2 and grade 3 MCL tears, which are more severe, need proper treatment in order to heal, which can include resting, wearing a knee brace and doing physical therapy. If you injure your knee, contact your healthcare provider as soon as possible.

Do MCL tears require surgery?

Most MCL tears heal well without surgery. However, if you have other knee injuries alongside an MCL tear, you will likely need to undergo surgery. Professional athletes may need to consider surgery to fix their MCL tear to prevent future MCL issues when they return to their sport.

What are the risk factors for MCL tears?

If you play certain sports such as football, soccer or skiing and/or had an MCL tear before, you are more likely to experience an MCL tear.

What can I do to prevent an MCL tear?

While not all MCL tears are preventable, there are steps you can take to lower your risk of tearing your MCL. Balance, strength and power exercises that focus on your thigh and hip muscles can help lower your risk of getting an MCL tear. In football linemen, braces have been shown to prevent MCL injuries.

What is the prognosis (outlook) for an MCL tear?

MCL tears usually heal well if they’re treated properly. Complications from MCL tears are rare. Most athletes who experience an MCL tear are able to return to their sport after their injury has healed.

How long does it take to fully recover from an MCL tear?

The time it takes to fully recover from an MCL tear depends on how severe the tear is. A grade 1 (mild) MCL tear usually heals within one to three weeks. A grade 2 (moderate) MCL tear generally takes four to six weeks to heal with treatment. A grade 3 (severe) MCL tear can take six weeks or more to heal with treatment. If you undergo surgery to fix your MCL tear, it could take longer.

How do I take care of myself if I have an MCL tear?

Be sure to follow your healthcare provider’s instructions for treatment, including those of your physical therapist. Commit to your physical therapy exercises and take your medications as prescribed by your provider. The more closely you follow your treatment plan, the sooner your MCL will heal.

When should I see my healthcare provider?

If you injure your knee, see your healthcare provider as soon as possible. They’ll need to evaluate the injury to see how severe it is, reduce the swelling and determine a treatment plan.

What questions should I ask my doctor?

If you have an MCL tear, it could be helpful to ask your healthcare provider the following questions:

• What kind of MCL tear do I have?
• What are my treatment options?
• How long do you predict it will take me to recover?
• What medications should I take?
• Do I need to see a specialist?
• Should I see a sports medicine specialist?
• When can I return to my sport?
• What are the pros and cons of surgery to repair my MCL tear?

A note from Cleveland Clinic

Although it can be upsetting to not be able to play your sport, an MCL tear will only temporarily prevent you from playing the sports and doing the activities you love. Recovering from an MCL tear depends on your willingness to follow your healthcare team’s treatment plan, which will likely include resting, using crutches and committing to physical therapy. The more you commit to your treatment plan, the better your MCL will be able to heal.