Document Title: Wilk-EKLR-Ch06-2000.shtml
Article Title: Assessment and Treatment of Medial Capsular Injuries
Author: Kevin E. Wilk, PT, William G. Clancy, Jr, MD, and James R. Andrews, MD, and Gregory M. Fox, MD
Publication: Knee Ligament Rehabilitation, edited by Todd S. Ellenbecker. Philadelphia, Pennsylvania: Churchill Livingstone (Harcourt), 2000. (This book has 51 contributing authors and 465 pages.)
Pages: 89-105
Keywords: Medial-capsular injuries, MCL injuries, MCL tearing, spraining, non-surgical rehabilitation, knee bracing.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables. Although this article has been published as a book chapter, it can be read independently of the other chapters in the book. Other chapters from this book can be found here.)

Comments: The authors discuss diagnostics and rehabilitation from MCL (medial collateral ligament, which is part of the medial capsule) injuries. Most MCL injuries "self-heal" (i.e. scar over) satisfactorily on their own, without surgical intervention. Although such a self-healed ligament is histologically not identical to a natural MCL, it usually provides a satisfactory restraint to valgus-directed forcing. The authors also note the importance of checking for meniscal injuries, particularly for cases in which an ACL injury accompanies the MCL tearing. With regards to bracing: the authors quote studies on prophylactic-type braces as used in the context of MCL injuries, and specially for college football. Given the problems that arise from the use of cheap prophylactic braces, high-quality custom-made functional braces would be a far better choice. High-quality custom-made functional braces provide reliable and dependable protection against sideways forcing (and also injurious hyperextension), thus making them extreme valuable for preventing MCL injuries and re-injuries. It would have been appropriate for the authors to distinguish clearly between custom-made functional braces and cheap off-the-shelf prophylactic braces.

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Introduction

Ligamentous injuries to the knee joint are a very common occurrence in sports and account for 25 to 40 percent of all knee injuries sustained.1,2 Sprains of the medial collateral ligament (MCL) occur most frequently, and this is the most frequently injured ligament of the knee.3-5 The MCL can be injured in isolation or in combination with other knee ligaments. Thus, the MCL, also referred to as the tibial collateral ligament, is a structure that has received much attention from clinicians and researchers in recent years.

Although the MCL has been the focus of increased attention by clinicians, because of the high incidence of injuries, there exists considerable controversy regarding the terminology and function of the MCL and surrounding capsular structures (posterior oblique ligament). In this chapter, we provide a discussion of the anatomy, biomechanics, mechanism of injury, and clinical examination of the medial capsular structures. Additionally, a thorough discussion of the treatment options (nonoperative and operative) as well as postoperative rehabilitation is conducted.

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