A 29-year-old male professional football player injured his left knee after sustaining a valgus stress to his flexed knee during a competitive match. Despite this injury he was able to complete the game. He presented the following day with localised medial knee pain. He was found to have tenderness on the medial side of the knee, pain with knee flexion and valgus laxity at 30º of knee flexion (there was no laxity when the knee was extended). There was no effusion.
An x-ray series was normal. MRI showed a loss of continuity at the mid-substance of the superficial and deep layers of the MCL with high T2 signal intensity. There was no joint effusion, normal cruciate ligaments and normal menisci.
This player was diagnosed with grade II MCL injury based on his physical examination findings (laxity in flexion only). A period of rehabilitation, including a progressive increase in activity level, was performed. He successfully returned to play at his pre-injury level approximately two months after the injury.
MCL injuries are one of the most common football-related injuries. The severity of the injury is classified from grade I to III according to the instability in valgus stress test. Grade I injuries do not have any laxity, grade II injuries have laxity when the knee is assessed in 30º of knee flexion while grade three injuries have laxity in both flexion and in full extension. An effusion is an uncommon clinical finding and when present should make one consider an alternate diagnosis. Imaging is generally not needed.
Most isolated MCL injuries do not require surgical treatment because the ligament has good healing potential. While non-surgical treatment is usually selected for grade I and II injuries, surgical treatment may be considered when there has been an avulsion from the tibial attachment, for some grade III injuries and when there has been a multi-ligament injury.
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