Medial Collateral Ligament (MCL) Injuries in Football
Injury to the medial collateral ligament (MCL) of the knee is the most reported injury in men’s football (Lundblad et al., 2014). It is estimated that a team of 25 players will suffer 2 MCL injuries per season, compared to one anterior cruciate ligament (ACL) injury each year (Waldén et al., 2010).
Mechanism of Injury:
A study by Buckthorpe et al (2021) reviewed video analysis of 37 MCL injuries over two seasons in professional football matches. This study noted that of the injuries analysed, 62% were direct contact, 24% in direct contact, and 14% were non-contact. The authors reported three main mechanisms of sprain injury to the MCL in order of highest incidence: 1. Direct contact with the knee joint, 2. Contact to the foot or leg (lever-like) 3 when a player is sliding. Further, 73% of these injuries occurred during two main situations: 38% occurred when pressing/tackling and 35% when being tackled.
Regarding the body’s positioning at the time of injury, 100% of the injuries occurred with the knee in a valgus position (knee bowed-in position, see image below), hip abduction occurred in 73% of cases, and tibial external rotation occurred in 92% of cases. These prominent injury positions were also associated with lateral trunk flexion (side-bending of the spine) and rotation in 64% of cases. The study also noted that knee flexion angles were higher in both in-direct and non-contact injuries when compared to direct-contact injuries.
A separate 3-year prospective study by Lundblad et al., 2019 examining 130 cases of MCL injuries found that 98 (75.4%) of the injuries involved contact with another player. Of these contact-related injuries, 38 (29.2%) involved being tackled and 15 (11.5%) involved tackling an opponent were the 2 most common sub-types of contact-related injuries to the MCL. 114 (87.7) of these cases were isolated lesions to the MCL, with the remaining 16 (12.3%) involving injuries to associated structures in the same side knee, with the medial meniscus being the most commonly affected. Only 4 (3.5%) of cases had reported a previous MCL injury to the same side knee.
MCL Injury lay-off times:
The study by Lundblad et al., 2019 notes the mean number of lay-off days from sport with an MCL injury is 24 days. However, the most common clinical grade of MCL tears in this study was a grade 1 (partial/minority of fibres torn) with a mean number of 10 lay-off days. An MCL injury has a greater chance of a full recovery when compared to an ACL injury, as it has a greater blood supply.
How can we reduce the risk of injury at the knee joint?
Have your posture, quality of motion, and athletic ability evaluated by a professional.
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Dan will design and walk you through a tailored personalised programme to optimise your movement quality and strength to mitigate the risk of injury and maximise your sports performance.
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References:
Buckthorpe, M., Pisoni, D., Tosarelli, F., Danelon, F., Grassi, A. and Della Villa, F. (2021). Three Main Mechanisms Characterize Medial Collateral Ligament Injuries in Professional Male Soccer—Blow to the Knee, Contact to the Leg or Foot, and Sliding: Video Analysis of 37 Consecutive Injuries. Journal of Orthopaedic & Sports Physical Therapy, 51(12), pp.611–618. doi:https://doi.org/10.2519/jospt.2021.10529.
Lundblad, M., Waldén, M., Magnusson, H., Hägglund, M., Karlsson, J. and Ekstrand, J. (2014). THE UEFA INJURY STUDY: 11-YEAR DATA CONCERNING 346 MCL INJURIES IN PROFESSIONAL FOOTBALL. British Journal of Sports Medicine, 48(7), pp.629.2-629. doi:https://doi.org/10.1136/bjsports-2014-093494.188.
Lundblad, M., Hägglund, M., Thomeé, C., Hamrin Senorski, E., Ekstrand, J., Karlsson, J. and Waldén, M. (2019). Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee Surgery, Sports Traumatology, Arthroscopy, 27(11). doi:https://doi.org/10.1007/s00167-019-05491-6.
Waldén, M., Hägglund, M., Magnusson, H. and Ekstrand, J. (2010). Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surgery, Sports Traumatology, Arthroscopy, [online] 19(1), pp.11–19. doi:https://doi.org/10.1007/s00167-010-1170-9.-like) 3 when a player is sliding. Further, 73% of these injuries occurred during two main situations: 38% occurred when pressing/tackling and 35% when being tackled. Regarding the body's orientation at the time of injury, 100% of the injuries occurred with the knee in a valgus position (bowed-in position, see image below), hip abduction occurred in 73% of cases, and tibial external rotation occurred in 92% of cases. These prominent injury positions were also associated with lateral trunk flexion (side-bending of the spine) and rotation in 64% of cases. The study also noted that knee flexion angles were higher in both in-direct and non-contact injuries when compared to direct-contact injuries.