Sports Topics > Physical Therapy & Sport Injury Rehabilitation & Prevention

Common Injuries: The Knee

Grade I Medial Collateral Ligament Sprain

Definition: A few ligamentous fibers are torn or stretched.

Characterized by:
• The joint is stable.
• There is little or no swelling.
• The joint may feel stiff and tender to touch.
• Even with mild stiffness, there is full range of motion.

Management:
• Immediate care consists of rest, ice, compression and elevation (RICE) for at least 24 hours.
• Crutches should be used if athlete is unable to walk without a limp.
• Follow-up care may involve various modalities, i.e. ultrasound, E-stim.
• Proper exercises are essential.

Return To Full Participation:
• When the knee has regained normal strength, power, flexibility, endurance and condition – usually one to three weeks.

Grade II Medial Collateral Ligament Sprain

Definition: A Grade II MCL knee sprain indicates both microscopic
(small) and gross (large) tears of ligamentous fibers charac-
terized by the following:
• A complete tear of the deep capsular ligament and partial tear of the superficial layer of MCL or partial tear of both areas.
• No gross instability, but may have slight instability (looseness) when the knee is straight. May have more looseness when knee is slightly bent.
• Slight or no swelling.
• Moderate to severe joint stiffness. Athlete may not be able to fully straighten the knee. Athlete may be unable to place the heel flat on the ground.
• Pain on the inside of the knee (medial aspect) with general weakness and instability.

Management:
• Rest, ice, compression and elevation (RICE) for 48 to 72 hours.
• Crutches until acute phase of injury is over and athlete can walk with a normal gait pattern.
• Modalities, i.e. E-stim, ice.
• Isometric exercises progressing to active resistive full range exercises as soon as possible.
• Closed chain exercises.
• Functional progression early in rehab.
• Use of tape or perhaps a hinged brace when attempting to return to running activities is encouraged.

Grade III Medial Collateral Ligament Sprain

Definition: A Grade lll MCL knee sprain indicates a complete tear of the
ligaments. The following are major signs and symptoms:
• Complete loss of stability to the inside of the knee.
• Little to moderate swelling.
• Immediate severe pain followed by dull ache.
• Loss of motion because of swelling and muscle guarding.

Management:
• RICE for 20 minutes every 2 hours during waking day for at least 72 hours.
• Conservative non-operative care is now recommended for Grade lll MCL tears.
• Motion and progressive weight bearing for 2 weeks, followed by protection with a functional hinged brace for another 2 to 3 weeks.
• Exercises and rehab would be similar to that of Grade I and II sprains, but recovery time would be greater.

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