Repair Medial Collateral Ligament Injuries at OrthoRegen
The Medial Collateral Ligament (MCL) is vital for stabilizing 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 medial collateral ligament is injured, other ligaments are often injured.
MCL injuries also affect the meniscus. A meniscus tear can accompany an MCL injury since part of the MCL is attached to the meniscus.
When a ligament in the knee is injured, the medial collateral ligament (MCL) is most commonly affected. In general, the MCL is a very strong ligament, and it is pretty resilient when injured. In many circumstances, physicians will opt for non-surgical treatments because they consider the MCL’s ability to heal on its own.
An athlete with an 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. We will also examine whether a medial collateral ligament injury should heal on its own or if this path allows for a weaker MCL. Also, does allowing the MCL to heal on its own make one more susceptible to re-injury?
The MCL has a greater blood supply than the ACL, which adds to its greater ability to heal. However, studies have shown that even though conservative therapy for MCL injuries is 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, an inferior type of healing that results in less strength than in normal ligaments. A weak ligament leads to ligament laxity and an unstable joint. Joint instability due to 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.
The abnormal movement alters how the knee can handle loads and pressures. The instability allows for more sliding between joint surfaces and decreases the efficiency of the muscles. This disrupts the underlying cartilage and bone and boosts overall degeneration, eventually forming arthritis.
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 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, a cascade of degeneration of the condyles starts. 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.
Medial collateral ligament sprains cause posteromedial knee pain. Injuries to coordinated muscles, ligaments, or menisci in the posteromedial aspect of the knee result in anteromedial rotational instability. Ligamentous knee instability causes destructive joint forces to occur, which results in the development of pathophysiologic conditions such as an injured MCL and continued knee dysfunction.
Prolotherapy promotes the repair of the injured or degenerated tissues by stimulating the physiological healing process of the joint. This process corrects the underlying joint instability, reduces associated pain, improves knee function, and can slow the degenerative process. (1)
Treatment of an Injured MCL
Traditional care of MCL injuries ranges from conservative to surgical measures. Surgery involves cutting and removing tissue, and since medial collateral ligament injuries often involve other structures, that would entail even more cutting.
It is essential to understand that the removal and cutting of knee structures add 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. They help to heal the entire knee and stabilize the injured MCL. Studies have shown that these treatments are effective at increasing the strength of the ligament at the attachment site and boosting the overall ligament mass and strength.
Regenerative Orthopedics for MCL injuries encourages collagen formation at the knee joint. It stimulates the body to repair itself. It heals the ligaments by stimulating new tissue formation rather than scar tissue formation. When the ligament is completely torn, surgery is necessary. But Regenerative Orthopedics is helpful when both ends of the ligament remain attached to bone. In 98% of ligament injuries, this is the case since the injuries are partial tears.
The medical journal Cureus says, “PRP and stem cell injections have been shown to improve an individual’s quality of life (QOL) and are associated with fewer side effects as compared to invasive standards of care in multiple MSK injuries such as plantar fasciitis, Achilles tendinopathy, acute muscle and tendon tears, ligament injuries, chondral and medial collateral ligament (MCL) knee injuries and arthritis, rotator cuff lesions, and avascular femoral necrosis.” (2)
Strong ligaments and tendons are the key to healthy knees. In the case of medial collateral ligament injuries, co-injury of ligaments, and other involved structures in MCL injuries, the goal is to treat the whole knee with Regenerative Orthopedics. The treatment will stimulate repair and strengthen the injured and weakened structures. New collagen, the material the ligaments and tendons are made of, is deposited at the repair site.
The result is a stronger, more stable knee joint. Rather than just allowing the MCL to heal independently, Regenerative Orthopedics ensures proper ligament tissue regeneration, allowing for effective pain elimination, the repair of the MCL injury, and a safe return to sport and activities.
(1) Hauser, R. A., Steilen-Matias, D., Johanna, B., Rawlings, B. R., Mann, J., Grogan, T., & Phillips, A. The Open Pain Journal, 2023.
(2) Schneider, Nicole, et al. “The use of platelet-rich plasma and stem cell injections in musculoskeletal injuries.” Cureus 16.5 (2024).
