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Q: I landed a jump with my feet apart while skiing the other day. I felt a pop and the inside of my right knee began to hurt immediately. I’m wondering if I tore my MCL?
A: It sounds like you did tear your medial collateral ligament (MCL). MCL tears are the most common ligament injuries occurring in winter sports, and account for 20–25% of all skiing injuries. Athletes engaging in winter sports like skiing and snowboarding may land awkwardly or suffer twisting injuries to their knee, resulting in painful and debilitating ligament injuries such as MCL tears.
The medial collateral ligament is located on the medial, or inner side, of the knee, and aids in the stabilization of the knee joint. This ligament runs from the bottom of the femur to the top of the tibia, and helps prevent the knee from collapsing inward. The MCL protects our knees from a valgus or knock kneed stress. MCL tears typically occur due to excessive force on the opposite side of the knee, such as when a football player tackles another player from the side. As the outside of the knee goes inward due to excessive force, the MCL becomes strained and the fibers can partially or completely tear apart. Most of the time, the MCL tears off of its attachment on the femur. However, the MCL can tear off of its attachment on the tibia. This distinction is important because tears off of the femur usually heal whereas tears off of the tibia may not.
Skiers using the “snow plow” position to stop may experience MCL tears due to the way in which the skis are turned. With the front of the skis pointed toward one another, the MCL is susceptible to tear if the inner edge of the ski catches and suddenly forces the knee into a further knocked knee position. The MCL can also tear when the lower leg is unexpectedly thrown outward (“catching an edge”). If an MCL injury is quickly diagnosed, it can usually be successfully treated with a hinged knee brace. Unfortunately, it is not uncommon for me to see athletes in the office who tore their MCL months ago and at that point bracing will not allow it to heal.
Orthopedists grade ligament tears on a one through three scale.
Grade 1 MCL Tear. The ligament is mildly damaged in a Grade 1 Tear. It has been slightly stretched with some fibers being torn but most fibers are intact. These heal predictably as long as the knee is protected for several weeks.
Grade 2 MCL Tear. In a Grade 2 Sprain, the MCL is partially torn and the knee is moderately unstable. If diagnosed early, these can heal with a hinged brace and activity modification in 6 weeks.
Grade 3 MCL Tear. There is a complete tear of the ligament. The ligament has been completely torn from its attachment onto the femur or tibia or there is a midsubstance rupture of the ligament. Isolated grade 3 MCL tears are uncommon as there is often an associated ACL tear. Isolated grade 3 MCL tears can completely heal with a hinged brace and activity modification but not uncommonly there is some mild residual laxity and incomplete healing.
As for activity modification, patients need to avoid all cutting and pivoting activity to give the MCL the best chance to heal as well as wear the brace continuously for 6 weeks or so depending on the severity of the tear. For isolated grade 3 MCL tears, I often put people on crutches for 4 weeks as well. Range of motion exercises are encouraged. Finally, good old “RICE” is helpful. This includes:
Dr. Rick Cunningham is a Knee and Shoulder Sports Medicine Specialist with Vail-Summit Orthopaedics. He is a Physician for the US Ski Team and Chief of Surgery at Vail Valley Medical Center. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit www.vsortho.com.