Caring Medical - Where the world comes for ProlotherapyMedial Collateral Ligament Knee Injury

Ross.Hauser.MD

 

Your doctor or MRI tells you that you have a partial tear of the medial collateral ligament (MCL)  of the knee. What are your treatment options? For most the best treatment is NOTHING – the injury should heal on its own. The MCL is a strong ligament and doctors in China have confirmed the resilience of the MCL in their published findings. What they noted, as many doctors who prefer to utilize non-surgical options, is that the most frequent MCL injury, near its femoral attachment can be healed spontaneously without surgical intervention.

Further the researchers pointed out that even a partially healed MCL might be enough for providing knee stability and prevention of further MCL strains. 1 In other words, a partial MCL tear is capable of healing itself and even before complete healing occurs is sufficient enough to keep the knee stable.

 Morphology of the medial collateral ligament of the knee. Liu F, Yue B, Gadikota HR, Kozanek M, Liu W, Gill TJ, Rubash HE, Li G - J Orthop Surg Res (2010)


Morphology of the medial collateral ligament of the knee. Liu F, et al.  J Orthop Surg Res (2010)

Now let’s introduce another recent study on the effects of Prolotherapy injections on an MCL tear.

A patient case study documents Prolotherapy treatment for a rugby player who had a grade 2 partial tear sprain of the MCL.

In his case, Prolotherapy, together with an exercise therapy program of three weeks had the the patient pain free, with a full range of motion, and he was able to perform all rugby-specific movements. 2

The success of this study was in how fast the player was able to return – three weeks as s opposed to 4 to 8 weeks for a grade two sprain. Prolotherapy induced a quicker “spontaneous healing.”


Medial collateral ligament injury


There is a lot or research and medical terms to describe injury to the medial collateral ligament. A recent paper isolates the problem to ligament elongation.3 Elongation is of course ligament laxity – extreme stretching of the ligament.

MCL injuries may also occur in conjunction with injuries to other ligaments of the knee, such as a lateral collateral ligament (LCL) injury, an anterior cruciate ligament (ACL) injury or a posterior cruciate ligament (PCL) injury. These four ligaments are the major stabilizing ligaments of the knee.

In recent research doctors say to treat the medial knee – you must know the relationship of all the ligaments and their place in the knee dynamic. A careful eye needs to be placed on the three important ligaments that maintain primary medial knee stability:

It is important not to exclude the assistance that other ligaments of the medial knee provide, including support of patellar stability by the medial patellofemoral ligament and multiligamentous hamstring tendon attachments. Valgus gapping and medial knee stability is accounted for collectively by every primary medial knee stabilizing structure.Doctors also show that Prolotherapy is effective in treating refractory tendinopathies especially of the knee,1

This research is supportive of certain surgical procedures in reconstructing the knee, what is standing out is that the surgeons are saying what comprehensive Prolotherapy doctors have been saying all along – you must treat the whole knee to fix the problem of one ligament.


RICE, Cortisone, and NSAIDs for MCL Injury


Conservative treatments for ligament sprain includes the RICE protocol, a treatment regime that involves rest, ice, compression and elevation, all of which may temporarily relieve the pain of the injury, but which most definitely do not assist in the healing of the injured soft tissue…the medial collateral ligament. The RICE protocol is designed to decrease swelling by decreasing circulation to the area. However, ligaments, which are already poor in blood supply, require this circulation for healing.

Another standard practice of modern medicine is to inject steroids into the injured area or to prescribe anti-inflammatory medications which have a long documented list of risk factors. The goal of a cortisone injection is to decrease the inflammation following an injury. Even though it may seem that cortisone brings temporary relief, these injections compromise the strength and health of the ligament.



Prolotherapy


Prolotherapy for an MCL injury involves injections inside the joint, to the MCL, and the surrounding affected tissues. This treatment is comprehensive in order to treat all of the weakened areas, as injury to the MCL often involves injury to the other ligaments and surrounding tissue of the knee joint.

Prolotherapy creates a mild inflammatory response that rouses the body to heal using the normal healing response. Blood flow is stimulated and regenerative cells boosted in the treated areas. The body responds by depositing collagen at the location of the injured ligaments. Collagen is the substance that makes up most of the ligament, and with this new collagen, the ligament is strengthened and tightened, once again becoming healthy.

Although a totally torn ligament usually requires surgery, Prolotherapy can play a key healing role here as well. First, because Prolotherapy has been shown to regenerate tissue, this treatment should be given a chance to help the ligament heal itself, even before surgery is considered. Secondly, Prolotherapy can also be a healing complement to surgery because the other ligaments around the knee, as well as the joint capsule itself, were at least stretched during the injury to the knee. Untreated, this stretching would most likely lead to instability of the knee joint.

Along with a controlled exercise program for healthy motion of the knee joint, Prolotherapy can successfully treat the injured medial collateral ligament and help patients get back to their normal activity levels.

Medial Collateral Ligament Knee Injury


1. Wan C, Hao Z, Wen S. The effect of healing in the medial collateral ligament of human knee joint: A three-dimensional finite element analysis. Proc Inst Mech Eng H. 2016 Jun 30. pii: 0954411916656662.
2. Ada AM, Yavuz F. Treatment of a medial collateral ligament sprain using prolotherapy: a case study. Altern Ther Health Med. 2015 Jul;21(4):68-71.
3. Guo Z, Freeman JW, Barrett JG, De Vita R. Quantification of strain induced damage in medial collateral ligaments. Biomech Eng. 2015 Jul 1;137(7).
4. LaPrade MD, Kennedy M, Wijdicks CA, LaPrade RF. Anatomy and biomechanics of the medial side of the knee and their surgical implications. Sports Med Arthrosc. 2015 Jun;23(2):63-70.

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