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Author Topic: MCL tear--I need to make a decision--please help with facts and/or experience  (Read 952 times)

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Offline chasbeachcomber

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I am an active 45 year old male.  I mountain climb, do yoga, run marathons etc.  I had a bad fall 4 months ago and tore my MCL ( grade 3).  There was a complete disrupture of the MCL with only a " few fibers intact". According to an MRI this week, it is now only 40% healed (approx.)  I have been in a  knee brace with hinges since July and have been on the bike (until recently) and doing PT.  I have developed  clicking in the knee in the last few weeks with increased pain. I was told by PT that the weakening leg hasd caused the patella to move of track, hence the clicking. My ACL is completly intact; my mensicus "looks like that of an 18 year old" .  I usually walk with the brace. When I don't have it on, the knee can feel great and then I  may get a sudden sharp pain.  A few steps later ithe pain abates.  However the Knee brace seems to cause pain in the calf and cause un natural gait that cause my hip to get tight.

My Dr. is a top guy and his reputation is flawless.  However, in matters like this, it seems like this is more of an art than science.  Do I do surgery ot not? Is 40 % healing enough? If I do not do the surgery  studies show that healing seems to max out in 4 months...but what percentage of patients continue to have healing?  My most pressing concern is if I do sports (like cross contry skiing) and have a fall  that injures the MCL, will I do damage the ACL, Meniscus, etc????  There seems to be laxity, but not to the point where it goes sideways while walking.  Will the clicking go away when I strengthen the leg or is it now a de facto something I will have to deal with because the MCL is only 40% healed?  Is 40% of an MCL ever enough?  IF it was 60 % healed, would that be enough?  What are the guidepost here.  Should I toss the hinged brace at this point, step up aggressive PT and hold off the surgery for a couple of months and see (via MRI, pain, laxiity, etc) if surgery is needed? Or, since it is four months at this time from the onset of the injury, should I just accept things as they are and get the surgery? 

Thank you for any insight that you can provide.


Offline Marjan

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Hi Charles,

I'm sorry you've joined "knee land", but glad you're taking the time and initiative to do some soul, or is that, knee searching.  As you probably know, no one can make a decision for you, nor do I think you expect that.  That said, how you proceed with your MCL is really a matter of your trilateral group, YOU (number one), your PT, and your OS.   Since you are doing the research, I recommend that, with an open mind, you read through some of the posts here. Search on MCL recon, etc.
I've had MCL issues myself, but never bad enough to have them graded.....just some laxity under examination.  MCLs do tend to take a LONG time to heal, and I don't blame you for worrying about the Terrible Triad (MCL, ACL, PCL) should you resume normal activity. 
How is your leg strength?  Are your quads strong? Do you workout hard (and carefully) enough to strengthen your entire leg?  No doubt, any instability in the knee can affect the other operatives (patella tracking, IT band, etc etc).  It is that issue (of developing other weaknesses) that I would put some weight in when making decisions on how to proceed.  I do not know enough about MCL surgery to know if it is generally successful, or whether the surgery itself weakens the ligament over time. 
I hope your relationship with your OS is open enough to raise these issues, as well as your PT's ability to "come clean" with you about pros and cons.  Everyone is different, no one can guarantee an outcome.  What are you willing to deal with?  There may be other, less disturbing, bracing that would help your MCL when you are active.  Not all braces are created equal.  There may be a definitive in/out surgery that can deal with your torn MCL, check out to see how long rehab for that is.....maybe your 40 percent (how'd they come up with that figure?) is not too bad in this time frame. I also feel that healing is not linear....if it took 4 months to get to 40 percent, it may take another 2 months to get to 100 percent.  The stronger your MCL, the more you can work the rest of the leg to encourage even more healing in the MCL.  I don't know, I have no answers, there's quite a bit of soul searching you have to go through, and should go through before you decide on a definitive track.  It's good that you are looking at the pitfalls of things, especially protecting your intact ligaments.
Good luck, no matter what, believe that you are doing the best you can for your knee..........the rest is just life.