mcl where is it located?

The medial collateral ligament (MCL) runs from the inside surface of the upper shin bone to the inner surface of the bottom thigh bone. This ligament keeps your shin bone (tibia) in place. The MCL is usually injured by pressure or stress on the outside part of the knee.

If you have -- or suspect you have -- an MCL injury or tear, you should know that the physicians at the University of Michigan Department of Orthopaedic Surgery have the expertise to diagnose and treat this painful condition. We are among the oldest and most well-regarded orthopaedic units in the country, performing more ACL, MCL, PCL and meniscus operations than some hospitals do in a five-year period.

We take an integrated, multidisciplinary approach that brings together the skills -- and the knowledge -- of all areas of our health system that will be involved in your care.

Our goal is to improve the quality of your life.

Note: If you have suffered a trauma -- whether it's from a fall or a sports injury -- it's important to seek treatment as soon you can, or you could risk further complications such as stiffness, prolonged pain or scar tissue in the joint. Getting that diagnosis quickly and accurately means we can treat you while the injury is simpler to treat.

Some typical symptoms include:

When you come to the University of Michigan:

Then we will use all of this information to develop an individualized treatment plan for you.

Most MCL tears don't require surgery, and we like to take a non-surgical approach first. Your doctor may recommend treatments such as:

The most important component in full recovery is physical therapy.

The medial collateral ligament (MCL), also called the superficial medial collateral ligament (sMCL) or tibial collateral ligament (TCL), is one of the major ligaments of the knee. It is on the medial (inner) side of the knee joint and occurs in humans and other primates. Its primary function is to resist valgus (inward bending) forces on the knee.

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 of the femur immediately below the adductor tubercle; 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. It provides up to 78% of the restraining force that resists valgus (inward pressing) loads on the knee.

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 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 muscles; a bursa is interposed between the two.

The MCL's deep surface covers the inferior medial genicular vessels and nerve and the anterior portion of the tendon of the semimembranosus muscle, with which it is connected by a few fibers; it is intimately adherent to the medial meniscus.

Embryologically and phylogenically, the ligament represents the distal portion of the tendon of adductor magnus muscle. In lower animals, adductor magnus inserts into the tibia. Because of this, the ligament occasionally contains muscle fibres. This is an atavistic variation.

An MCL injury can be very painful and is caused by a valgus stress 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 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. The center 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.

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. Most injuries that are partial and isolated can be treated without surgery. 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.

The medial collateral ligament (MCL) is a flat band of connective tissue that runs from the medial epicondyle of the femur to the medial condyle of the tibia and is one of four major ligaments that supports the knee. MCL injuries often occur in sports, being the most common ligamentous injury of the knee, and 60% of skiing knee injuries involve the MCL).

NB The MCL is also known as the  tibial collateral ligament (see image)

The MCL

This structure is divided into superficial and deep ligaments.

2. The Deep medial ligament (dMCL) is divided into two, the meniscofemoral and meniscotibial ligaments.

The medial collateral ligament is recognised as being a primary static stabiliser of the knee and assists in passively stabilising the joint.

The superficial and deep ligaments each have a unique function, making the MCL the primary responder to valgus stress and a secondary restraint to rotational forces.

Together, the MCL also helps guide the knee joint through its full range of motion when a tensile load is applied.

The MCL also prevents hyperextension of the joint and posterior translation of the tibia, secondary to the function of the posterior cruciate ligament (PCL). The posterior oblique ligament, a continuum of oblique fibers at the posterior aspect of the MCL, is responsible for this function.

The ligament also plays a role in joint position sense or proprioceptive feedback. When the MCL is stretched beyond its ability or exposed to an excessive load, it evokes neurological feedback signals that then generate a muscle contraction.

Branches of the superior and inferior genicular arteries supply the MCL. The area near the bony insertions is more richly vascularized.

The MCL is innervated by the medial articular nerve, a branch of the saphenous nerve.

The MCL is one of the most commonly injured ligaments of the knee.

Injuries to the MCL can have detrimental effects to surrounding structures.

Assessment of the MCL is best within 20 to 30 minutes of injury before pain, swelling, and muscle spasms make examination difficult. The assessment includes palpation and a special test, the valgus stress test VST

The anterior aspect of the ligament can be palpated moving vertically, roughly midway along the medial joint line. Focal tenderness indicates an MCL injury.

2. Special test

The VST assesses laxity of the MCL compared to the contralateral knee as a control. An increase in laxity and joint space usually distinguishes damage to the medical collateral ligament.

The patient should be positioned supine.

When assessing for an MCL injury, the examiner should carefully inspect surrounding structures. Suspicion of additional injury may require imaging.

Treatment is often non-operative because the MCL has strong vascular support for healing. See Medial Collateral Ligament Injury.