Medial collateral ligament
Encyclopedia
The medial collateral ligament of the knee
is one of the four major ligament
s of the knee. It is on the medial (inner) side of the knee joint in humans and other primates. It is also known as the tibial collateral ligament, or abbreviated as the MCL.
immediately below the adductor tubercle
; below to the medial condyle of the tibia
and medial surface of its body. It resists forces that would push the knee medially, which would otherwise produce valgus deformity
.
The fibers of the posterior part of the ligament are short and incline backward as they descend; they are inserted into the tibia above the groove for the semimembranosus muscle.
The anterior part of the ligament is a flattened band, about 10 centimeters long, which inclines forward as it descends.
It is inserted into the medial surface of the body of the tibia about 2.5 centimeters below the level of the condyle.
Crossing on top of the lower part of the MCL is the pes anserinus
, the joined tendons of the sartorius
, gracilis
, and semitendinosus muscles; a bursa is interposed between the two.
The MCL's deep surface covers the inferior medial genicular vessels and nerve and the anterior portion of the tendon of the semimembranosus muscle, with which it is connected by a few fibers; it is intimately adherent to the medial meniscus
.
Embryologically and phylogenically, the ligament represents the distal portion of the tendon of adductor magnus muscle. In lower animals, adductor magnus inserts into the tibia. Because of this, the ligament occasionally contains muscle fibres. This is an atavistic
variation.
to a slightly bent knee, often when landing, bending or on high impact. Depending on the grade of the injury, the lowest grade (grade 1) can take between 2 and 10 weeks for the injury to fully heal. Recovery times for grades 2 and 3 are difficult to predict because of the amount of damage done can take weeks to several months. It is difficult to apply pressure on the injured leg for at least a few days.
is the medial collateral ligament, although the carve turn
has diminished the incidence somewhat.
. Mostly the center
and the guards
are ones who get this injury, due to the grip trend on their cleats(sometimes a helmet hits their knee). The number of football players who get this injury has increased in recent years. Companies are currently trying to develop better cleats that will prevent the injury.
For higher grade tears of the MCL with ongoing instability, the MCL can be sutured or replaced. Other non-surgical approaches for more severe MCL injuries may include prolotherapy, which has been shown by Reeves in a small RCT to reduce translation on KT-1000 arthrometer versus placebo. The future of non-surgical care for a non-healing MCL injury with laxity (partial ligament tear) is likely bioengineering. Fan et al. (2008) have demonstrated that knee ligament reconstruction is possible using mesenchymal stem cells and a silk scaffold.
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
is one of the four major ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s of the knee. It is on the medial (inner) side of the knee joint in humans and other primates. It is also known as the tibial collateral ligament, or abbreviated as the MCL.
Structure
It is a broad, flat, membranous band, situated slightly posterior on the medial side of the knee joint. It is attached proximally to the medial condyle of femurMedial condyle of femur
The medial condyle is one of the two projections on the lower extremity of femur.The medial condyle is larger than the lateral condyle due to more weight bearing caused by the center of gravity being medial to the knee. On the posterior surface of the condyle the linea aspera turns into the...
immediately below the adductor tubercle
Adductor tubercle
The medial lip of the linea aspera ends below at the summit of the medial condyle, in a small tubercle, the adductor tubercle, which affords insertion to the tendon of the vertical fibers of Adductor magnus.-External links:*...
; below to the medial condyle of the tibia
Medial condyle of tibia
The medial condyle is the medial portion of the upper extremity of tibia.It is the site of insertion for the Semimembranosus muscle....
and medial surface of its body. It resists forces that would push the knee medially, which would otherwise produce valgus deformity
Valgus deformity
In orthopedics, a valgus deformity is a term for outward angulation of the distal segment of a bone or joint. The opposite deformation, medial deviation of the distal bone, is called varus....
.
The fibers of the posterior part of the ligament are short and incline backward as they descend; they are inserted into the tibia above the groove for the semimembranosus muscle.
The anterior part of the ligament is a flattened band, about 10 centimeters long, which inclines forward as it descends.
It is inserted into the medial surface of the body of the tibia about 2.5 centimeters below the level of the condyle.
Crossing on top of the lower part of the MCL is the pes anserinus
Pes anserinus (leg)
The pes anserinus is the insertion of the conjoined tendons of three muscles onto the anteromedial surface of the proximal extremity of the tibia.-Anatomy:The three muscles are :* sartorius...
, the joined tendons of the sartorius
Sartorius muscle
The Sartorius muscle – the longest muscle in the human body – is a long thin muscle that runs down the length of the thigh. Its upper portion forms the lateral border of the femoral triangle.-Origin and insertion:...
, gracilis
Gracilis muscle
The gracilis is the most superficial muscle on the medial side of the thigh. It is thin and flattened, broad above, narrow and tapering below.-Origin and insertion:...
, and semitendinosus muscles; a bursa is interposed between the two.
The MCL's deep surface covers the inferior medial genicular vessels and nerve and the anterior portion of the tendon of the semimembranosus muscle, with which it is connected by a few fibers; it is intimately adherent to the medial meniscus
Medial meniscus
-External links: *...
.
Embryologically and phylogenically, the ligament represents the distal portion of the tendon of adductor magnus muscle. In lower animals, adductor magnus inserts into the tibia. Because of this, the ligament occasionally contains muscle fibres. This is an atavistic
Atavism
Atavism is the tendency to revert to ancestral type. In biology, an atavism is an evolutionary throwback, such as traits reappearing which had disappeared generations before. Atavisms can occur in several ways...
variation.
Causes of injury
An MCL injury can be very painful and is caused by a valgus stressValgus stress
The Valgus stress test is a test for ligament damage. It involves placing the leg into extension, with one hand placed as a pivot on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is then made to force the leg at the knee into valgus...
to a slightly bent knee, often when landing, bending or on high impact. Depending on the grade of the injury, the lowest grade (grade 1) can take between 2 and 10 weeks for the injury to fully heal. Recovery times for grades 2 and 3 are difficult to predict because of the amount of damage done can take weeks to several months. It is difficult to apply pressure on the injured leg for at least a few days.
Skiing
The most common knee structure damaged in skiingSkiing
Skiing is a recreational activity using skis as equipment for traveling over snow. Skis are used in conjunction with boots that connect to the ski with use of a binding....
is the medial collateral ligament, although the carve turn
Carve turn
A carve turn is a skiing term, used to refer to a turning technique in which the ski shifts to one side or the other on its edges. In this case, the ski turns itself and is driven by the sidecut geometry while losing no speed, unlike a normal parallel turn....
has diminished the incidence somewhat.
American football
MCL strains and tears are fairly common in American footballAmerican football
American football is a sport played between two teams of eleven with the objective of scoring points by advancing the ball into the opposing team's end zone. Known in the United States simply as football, it may also be referred to informally as gridiron football. The ball can be advanced by...
. Mostly the center
Center (American football)
Center is a position in American football and Canadian football . The center is the innermost lineman of the offensive line on a football team's offense...
and the guards
Guard (American football)
In American and Canadian football, a guard is a player that lines up between the center and the tackles on the offensive line of a football team....
are ones who get this injury, due to the grip trend on their cleats(sometimes a helmet hits their knee). The number of football players who get this injury has increased in recent years. Companies are currently trying to develop better cleats that will prevent the injury.
Treatment
Treatment of a partial tear or stretch injury is usually conservative. This includes measures to control inflammation as well as bracing. Kannus has shown good clinical results with conservative care of grade II sprains, but poor results in grade III sprains. As a result, more severe grade III and IV injuries to the MCL that lead to ongoing instability may require arthroscopic surgery. However, the medical literature considers surgery for most MCL injuries to be controversial. Since isolated MCL injuries are uncommon, surgery is often focused on ACL replacement or repair with combined surgical approaches being common.For higher grade tears of the MCL with ongoing instability, the MCL can be sutured or replaced. Other non-surgical approaches for more severe MCL injuries may include prolotherapy, which has been shown by Reeves in a small RCT to reduce translation on KT-1000 arthrometer versus placebo. The future of non-surgical care for a non-healing MCL injury with laxity (partial ligament tear) is likely bioengineering. Fan et al. (2008) have demonstrated that knee ligament reconstruction is possible using mesenchymal stem cells and a silk scaffold.