MCL Tear Symptoms You Shouldn’t Ignore
Key takeaways:
The MCL is a stabilizing ligament at the inner side of the knee. Direct impact to the knee can cause this ligament to overstretch, leading to a sprain or tear.
MCL tear symptoms include pain at the inner side of the knee, swelling, stiffness, and knee instability.
Many MCL tears can be treated with rest, pain medication, and physical therapy. Significant tears — especially those that occur with other knee injuries — may require surgery.
Table of contents
The medial collateral ligament (MCL) is a ligament on the inner side of the knee. This important ligament connects the thigh bone to the shinbone and provides stability.
The MCL is the most commonly injured ligament of the knee. A blow to the outside of the knee or sudden changes in direction that twist the knee can cause the MCL to tear. So, it’s common in American football and soccer, as well as basketball and skiing, for example.
MCL tear symptoms can limit your daily and sporting activities. The good news is that many MCL tears can heal with conservative (nonsurgical) treatment. Keep reading to learn more about MCL tear causes, symptoms, and treatments.
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What are the symptoms of an MCL tear?
Symptoms of an MCL tear are typically localized to the inner side of the knee. If an injury also caused damage to another part of the knee, symptoms may be felt throughout the entire knee, including:
Pain: Pain is located at the inner side of the knee where the MCL connects the thigh bone to the shinbone. It can be difficult to bear weight on that leg.
Swelling: Swelling often develops after an MCL injury. Swelling may be located just at the inner side of the knee where the MCL is located. If the injury is severe, swelling may spread across the entire knee.
Knee instability: Damage to the MCL can make the knee feel unstable. This is usually felt when transferring weight from one leg to the other.
Stiffness: Pain and swelling can make it difficult to move the knee. This can lead to stiffness of the knee joint with bending and straightening.
What causes an MCL tear?
An MCL tear results from an injury to the knee that overstretches the MCL. This often occurs with a direct blow to the outer side of the knee when the foot is planted. This combination strains the MCL on the inner side of the knee, causing the ligament to tear.
MCL tears can also happen from quick twisting or turning movements, like suddenly changing direction. In a situation like this, your shoe, ski, or skate could get caught on the ground or playing surface and lead to an MCL tear.
Less commonly, the MCL can be injured from a hyperextended knee.
How is an MCL tear diagnosed?
A medical professional will diagnose an MCL tear based on a variety of factors. These include how the injury happened, your symptoms, and a physical examination. Imaging methods may also be used to examine the structures of your knee. If you’re in pain and a physical exam isn’t possible, imaging is an alternative, too.
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X-rays examine the bones of the knee joint. Certain X-rays views can show the space between the bones at the inner side of the knee. This can help determine if the MCL is injured.
An MRI isn’t usually necessary to diagnose an MCL tear. But it can be helpful if your clinician suspects another ligament or cartilage injury in the knee. That’s because MRIs examine soft tissues, including ligaments, tendons, and cartilage.
Grades of injury
An MCL injury is given a grade from 1 to 3 based on the amount of damage to the ligament. The grade of an MCL tear can be determined from an MRI.
The grades of MCL injuries include:
Grade 1: A mild injury or sprain — and the knee is still stable
Grade 2: A partial tear, which makes the knee somewhat unstable
Grade 3: A complete tear, which makes the joint unstable
Treatment for grade 1 and grade 2 MCL injuries doesn’t include surgery.
But grade 3 tears commonly occur with another injury, usually the anterior cruciate ligament (ACL). So, these are more likely to require surgery.
Treating and managing an MCL tear
Managing an MCL tear will most often involve a variety of at-home treatments. Many MCL tears can be treated conservatively with physical therapy and pain-relieving methods.
Treatment options include:
Rest: Resting from aggravating activities and high-impact exercise is needed for an MCL tear to heal. This involves taking time off from sports and regular exercise. This includes running and prolonged walking.
Ice: Applying ice or a cold pack to your knee for 20 minutes at a time can help reduce pain and swelling. Be sure to put a thin towel under the ice to protect your skin.
Compression: Applying compression to the knee can help support your knee. This may help decrease pain and swelling.
Elevation: Elevating your leg above the level of your heart can also help reduce swelling.
Physical therapy: Physical therapy can help rehabilitate your knee and MCL to get you back to your daily activities. These exercises will focus on restoring your range of motion, strengthening your leg muscles, and improving your balance and agility.
Bracing: Some experts recommend wearing a hinged knee brace after an MCL injury. This helps protect the ligament during healing while allowing the knee to bend. But it’s best to avoid complete immobilization.
OTC pain relievers: Over-the-counter (OTC) medication, such as acetaminophen, can help reduce pain. Taking these medications for a short period of time after injury can help you manage your daily tasks.
Surgery: Sometimes a grade 3 MCL tear requires surgery to repair or reconstruct the MCL. Surgery is often needed if there are other injuries in the knee, or to treat ongoing instability after chronic MCL injury.
Frequently asked questions
Fortunately, many MCL tears can heal on their own because this ligament has a pretty good blood supply at the ends. But you’ll need conservative treatment, including an initial period of rest and physical therapy. This will help restore your movement and strength. Without appropriate rehab, there’s a risk of reinjury or instability.
You can help prevent an MCL tear by strengthening the muscles that support your knee. Improved strength through the glutes, quadriceps, and hamstrings will help support and stabilize the knee. This can help decrease stress at the MCL during exercise and while playing sports.
An MCL sprain is a mild version of the injury, and a tear is more severe. An MCL sprain is essentially the same as a grade 1 injury. This is because the injury causes tiny, microscopic tears, but most of the ligament is intact. Typically, partial or full tears result in worse symptoms — like more pain and swelling — than sprains.
The bottom line
An MCL tear is an injury to the stabilizing ligament at the inner side of the knee. The MCL can tear with twisting or direct impact to the knee, especially when the foot is planted. Pain and swelling often develop at the inner side of the knee, which may also lead to stiffness and instability. MCL tear treatment will depend on the severity of the injury. But many cases can be treated without surgery.
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References
Andrews, K., et al. (2017). Review: Medial collateral ligament injuries. Journal of Orthopaedics.
Braaten, J. A., et al. (2022). From anatomy to complex reconstruction: A modern review on the medial collateral ligament of the knee. The Archives of Bone and Joint Surgery.
Gentile, J. M., et al. (2021). A biomechanical comparison shows no difference between two knee braces used for medial collateral ligament injuries. Arthroscopy, Sports Medicine, and Rehabilitation.
InformedHealth.org. (2024). In brief: What are ligaments? Institute for Quality and Efficiency in Healthcare.
Memarzadeh, A., et al. (2019). Medial collateral ligament of the knee: Anatomy, management and surgical techniques for reconstruction. Orthopaedics and Trauma.
Witstein, J. R., et al. (2021). Collateral ligament injuries. OrthoInfo.
