Abstract
PurposeMedial collateral ligament (MCL) injury is the single most common traumatic knee injury in football. The purpose of this study was to study the epidemiology and mechanisms of MCL injury in men’s professional football and to evaluate the diagnostic and treatment methods used.MethodsFifty-one teams were followed prospectively between one and three full seasons (2013/2014–2015/2016). Individual player exposure and time-loss injuries were recorded by the teams’ medical staffs. Moreover, details on clinical grading, imaging findings and specific treatments were recorded for all injuries with MCL injury of the knee as the main diagnosis. Agreement between magnetic resonance imaging (MRI) and clinical grading (grades I–III) was described by weighted kappa.ResultsOne hundred and thirty of 4364 registered injuries (3%) were MCL injuries. Most MCL injuries (98 injuries, 75%) occurred with a contact mechanism, where the two most common playing situations were being tackled (38 injuries, 29%) and tackling (15 injuries, 12%). MRI was used in 88 (68%) of the injuries, while 33 (25%) were diagnosed by clinical examination alone. In the 88 cases in which both MRI and clinical examination were used to evaluate the grading of MCL injury, 80 (92% agreement) were equally evaluated with a weighted kappa of 0.87 (95% CI 0.77–0.96). Using a stabilising knee brace in players who sustained a grade II MCL injury was associated with a longer lay-off period compared with players who did not use a brace (41.5 (SD 13.2) vs. 31.5 (SD 20.3) days, p = 0.010).ConclusionThree-quarter of the MCL injuries occurred with a contact mechanism. The clinical grading of MCL injuries showed almost perfect agreement with MRI grading, in cases where the MCL injury is the primary diagnosis. Not all grade II MCL injuries were treated with a brace and may thus indicate that routine bracing should not be necessary in milder cases.Level of evidenceProspective cohort study, II.
Highlights
The medial collateral ligament (MCL) acts as the primary biomechanical knee joint valgus restraint at 0° and 30° of knee flexion [1, 2]
There is a lack of evidence to support the efficacy of plateletrich plasma (PRP) injections to treat MCL lesions in humans, but there is some emerging evidence to show that the use of PRP injections in the early stages of healing may improve outcome in animal models of acute MCL injuries [5, 15]
The study design was approved by the Union of European Football Associations (UEFA) Medical Committee and the UEFA Football Development Division
Summary
The medial collateral ligament (MCL) acts as the primary biomechanical knee joint valgus restraint at 0° and 30° of knee flexion [1, 2]. Compared with other knee injuries, such as the anterior cruciate ligament (ACL) injury, the epidemiological literature on MCL injuries in sports is scarce, but they are prevalent in contact sports such as football [5], ice hockey, rugby, wrestling and judo [6,7,8]. MCL injury has been reported as the most common traumatic knee injury leading to time loss in men’s professional football [9]. A men’s professional football team with a typical 25-player squad will suffer two MCL injuries each season on average, whereas the same team will encounter only one ACL injury every second season [10]. Isolated grade I and II MCL injuries are treated almost exclusively non-surgically with progressive physiotherapy and sometimes a stabilising knee brace, while grade III injuries may require additional surgical intervention with a ligament repair or reconstruction [1]. There is a lack of evidence to support the efficacy of plateletrich plasma (PRP) injections to treat MCL lesions in humans, but there is some emerging evidence to show that the use of PRP injections in the early stages of healing may improve outcome in animal models of acute MCL injuries [5, 15]
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