The medial collateral ligament (MCL), or tibial collateral ligament (TCL), is one of the four major ligaments of the knee. It is on the medial (inner) side of the knee joint in humans and other primates. Its primary function is to resist outward turning forces on the knee.

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

epicondyle An epicondyle () is a rounded eminence on a bone that lies upon a condyle ('' epi-'', "upon" + ''condyle'', from a root meaning "knuckle" or "rounded articular area"). There are various epicondyles in the human skeleton, each named by its anatomic ...

of the femur immediately below the

adductor tubercle The adductor tubercle is a tubercle on the lower extremity of the femur. It is formed where the medial lips of the linea aspera end below at the summit of the medial condyle. It is the insertion point of the tendon of the vertical fibers of the ...

; 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 A valgus deformity is a condition in which the bone segment distal to a joint is angled outward, that is, angled laterally, away from the body's midline. The opposite deformation, where the twist or angulation is directed medially, toward the ...

. 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 The semimembranosus muscle () is the most medial of the three hamstring muscles in the thigh. It is so named because it has a flat tendon of origin. It lies posteromedially in the thigh, deep to the semitendinosus muscle. It extends the hip j ...

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 The semitendinosus () is a long superficial muscle in the back of the thigh. It is so named because it has a very long tendon of insertion. It lies posteromedially in the thigh, superficial to the semimembranosus. Structure The semitendinosus, r ...

muscles; a bursa is interposed between the two. The MCL's deep surface covers the

inferior medial genicular The inferior genicular arteries (inferior articular arteries), two in number, arise from the popliteal beneath the gastrocnemius. On the inside of the knee, is the medial inferior genicular artery, and on the outer side is the lateral inferior geni ...

vessels and nerve and the anterior portion of the tendon of the

muscle, with which it is connected by a few fibers; it is intimately adherent to the

medial meniscus The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia.Platzer (2004), p 208 It is also referred to as the internal semi ...

Development

Embryologically and phylogenically, the ligament represents the distal portion of the tendon of

adductor magnus Adductor may refer to: * One of the anatomical terms of motion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminolo ...

muscle. In lower animals, adductor magnus inserts into the tibia. Because of this, the ligament occasionally contains muscle fibres. This is an atavistic variation.

Clinical significance

Injury

An MCL injury can be very painful and is caused by a

valgus stress The valgus stress test or medial stress test is a test for damage to the medial collateral ligament of the knee. It involves placing the leg into extension, with one hand placed as a pivot Pivot may refer to: *Pivot, the point of rotation in a ...

to a slightly bent knee, often when landing, bending or on high impact. It may be difficult to apply pressure on the injured leg for at least a few days. It can be caused by a direct blow to lateral side of knee. The most common knee structure damaged in

skiing Skiing is the use of skis to glide on snow. Variations of purpose include basic transport, a recreational activity, or a competitive winter sport. Many types of competitive skiing events are recognized by the International Olympic Committee ( ...

is the medial collateral ligament, although the carve turn has diminished the incidence somewhat. MCL strains and tears are also fairly common in

American football American football (referred to simply as football in the United States and Canada), also known as gridiron, is a team sport played by two teams of eleven players on a rectangular field with goalposts at each end. The offense, the team with ...

. The

center Center or centre may refer to: Mathematics *Center (geometry), the middle of an object * Center (algebra), used in various contexts ** Center (group theory) ** Center (ring theory) * Graph center, the set of all vertices of minimum eccentrici ...

and the guards are the most common victims of this type of injury due to the grip trend on their cleats, although sometimes it can be caused by a helmet striking the 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. MCL is also crucially affected in breaststroke and many professional swimmers suffer from chronic MCL pains. There are three distinct levels in a MCL injury. Grade 1 is a minor sprain, grade 2 in a major sprain or a minor tear, and grade 3 is a major tear. Based on the grade of the injury treatment options will vary.

Treatment

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 can take several weeks to several months. Treatment of a partial tear or stretch injury is usually conservative. Sports medicine therapists should be a first choice option for diagnosis and treatment of injuries to this structure. 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. Isolated MCL sprains are 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 Prolotherapy, also called proliferation therapy, is an injection-based treatment used in chronic musculoskeletal conditions. It has been characterised as an alternative medicine practice. Medical uses A 2015 review found no evidence that prolother ...

, 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.

Additional images

File:Slide2CAC.JPG, Anterior view of knee

References

External links

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Medial Collateral Ligament (MCL) Tears
{{DEFAULTSORT:Medial Collateral Ligament Knee ligaments