When a ligament in the knee is injured, the most common ligament affected is the medial collateral ligament (MCL). In general, the MCL is a very strong ligament and is pretty resilient when injured, and in many circumstances, physicians will opt for non-surgical treatments, because they take into consideration the ability of the MCL to heal on its own. An athlete with injury to their MCL often returns to their usual training or routine after just a few weeks. But is this the best course of treatment for an injured MCL? In this article, we will explore the injury and healing process of the knee and its MCL, and also examine whether an injured MCL should just heal on its own or if this path allows for a weaker MCL, and one more susceptible to re-injury.
Let’s Take a Look at the Medial Collateral Ligament (MCL)
The MCL is a vital knee structure for providing stability to the knee joint. It is one of four major ligaments of the knee, along with the anterior cruciate (ACL), the posterior cruciate (PCL), and the lateral collateral (LCL) ligaments, all of which stabilize the knee. When the MCL is injured, very often these other ligaments are injured too! MCL injuries also affect the meniscus. Since part of the MCL is attached to the meniscus, a tear of the meniscus can also accompany an MCL injury.
Why is spontaneous or self-healing a consideration in MCL injuries? The MCL has a greater blood supply than the ACL, for example, which adds to its greater ability to heal. However, studies have shown that even though conservative therapy for MCL injuries has been shown to be more effective than in ACL or even PCL injuries, the healed MCL remains weaker and less efficient than the ligament in its pre-injured state. The ligament heals by scar formation, which is an inferior type of healing, and results in less strength than in normal ligaments, and the weak ligament leads to ligament laxity and an unstable joint. Joint instability as the result of an MCL injury begins the process of arthritis. The healing scarred ligament becomes longer and loose, which causes the joint to move and rotate differently, which alters how the knee can handle loads and pressures placed upon it. The instability allows for more sliding between joint surfaces, decreasing the efficiency of the muscles, disrupting the underlying cartilage and bone, and boosts overall degeneration which leads to the eventual arthritis formation.
An Injury to One Knee Structure Affects the Rest of the Knee
Wear and tear, trauma type injuries, and anything else that affects one ligament of the knee, will affect the other structures of the knee. The MCL helps the knee to bend and twist correctly, but when it is injured, those dynamics are changed. MCL injuries usually occur near where the ligament attaches to the thigh bone at the knee. The ligament attaches to a bony prominence called the medial condyle and assists in keeping the knee from hyperextending. When the MCL becomes weak and unstable, it starts a cascade of degeneration of the condyles. Since the medial condyle bears a lot of weight, the weak ligament boosts the wear on the bony condyle, and as the bone wears, the degeneration will also cause injury to the meniscus. The cycle then continues as these bony attachments continue to degenerate, because the attached ligaments will lose their tautness and become even more loose and weak.
Treatment of an Injured MCL
The care of MCL injuries ranges from conservative to surgical measures. Surgery involves the cutting and removal of tissue, and since MCL injuries often involve other structures, that would entail even more cutting. It is important to understand that removal and cutting of knee structures adds to knee instability and to further degeneration of the knee in the long run, so avoidance of surgery would be preferred. What can be done then, and what are your options, considering the inferior healing of the MCL when left to heal on its own? Regenerative Orthopedics, including Stem Cell Therapy, PRP, and Prolotherapy are treatment options available for MCL injuries, because they help to provide healing to the entire knee and also allow for stabilization of the injured MCL. Studies have shown that these treatments are effective at increasing the strength of the ligament at the attachment site, as well as boosting the overall ligament mass and strength.
Regenerative Orthopedics for MCL injuries encourages collagen formation at the knee joint, stimulates the body to repair itself, and heals the ligaments, by stimulating new tissue formation, rather than scar tissue formation. Surgery will be necessary when the ligament is completely torn, but Regenerative Orthopedics is helpful when both ends of the ligament remain attached to bone, and in 98% of ligament injuries this is the case, since the injuries are partial tears.
The key to healthy knees is strong ligaments and tendons. In the case of the injured MCL, co-injury of ligaments, and other involved structures in MCL injuries, the goal is to treat the whole knee with Regenerative Orthopedics to stimulate repair, and strengthen the injured and weakened structures. The treatment will lead to the deposits of new collagen, the material the ligaments and tendons are made of. The end result is a stronger, more stable knee joint. Rather than just allowing the MCL to heal on its own, Regenerative Orthopedics ensures proper regeneration of the ligament tissue, allowing for effective elimination of pain, the repair of the MCL injury, and a safe return to sport and activities.