Injuries to the knee's medial cruciate ligament (MCL) may be treated successfully without surgery, according to a literature review published in the March 2009 issue of The Journal of the American Academy of Orthopaedic Surgeons (JAAOS). The key, the review's authors found, is properly diagnosing and understanding the extent of the injury to determine the best course of treatment.
The MCL is the most frequently injured ligament in the knee. It attaches to the femur (thigh bone) and the tibia (shin bone) and runs across the inside of the knee. MCL injuries are usually caused by a direct blow to the knee, very common in contact sports such as football, rugby or soccer.
Injuries to the MCL may be isolated, or they may be part of a more complex injury involving the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) or meniscus (cartilage between the bones in the knee joint). Knowing whether other structures in the knee are involved is vital to treating these injuries.
"In most cases, MCL injuries can be treated non-operatively, with a combination of rehabilitation and bracing," says Ryan G. Miyamoto, M.D., sports medicine fellow at the Steadman-Hawkins Clinic in Vail, Colorado. "Surgery becomes an option when there are multiple injuries present in the knee. However, the additional injuries are not always identified."
Thorough physical examinations and appropriate imaging are of paramount importance in managing MCL injuries, say the study authors. In addition, they add that high-grade MCL injuries are often associated with other ligament injuries, so orthopaedic surgeons should pay particular attention to the other joint structures in those cases.
Non-surgical treatment of MCL injuries generally consists of:
- Early rehabilitation with range of motion and strengthening exercises, along with use of a hinged knee brace.
- Anti-inflammatory medications and low-intensity ultrasound are also being used with some success.
- Other nonsurgical treatments, such as gene therapy, growth factors, and small intestine submucosa, which is a naturally derived biomaterial isolated from the small intestine of pigs.
All are currently in their early stages of use, but may hold some promise.
Surgical treatment of MCL injuries may include primary repair or reconstruction of the ligament(s), depending on the stability of the knee. Rehabilitation and bracing is required following surgery.
"We need to be very critical of the stability of the knee, which can be a factor in how well the knee heals and whether it is reinjured," Miyamoto says. "Injuries like these are best overseen by an orthopaedic surgeon."