What Do You Say Jay, Could You Have Played?

Jay, who am I to judge, or any of us for that matter, your fortitude? A MCL or medial collateral ligament injury can be quite painful, even career ending. You now have everyone and their brother questioning your heart, your toughness. While I can't speak for that, I can tell you that recovery from your injury will be a lot easier than managing the firestorm of social media and critics that now surround you. Thank God your coach and teammates have your back.

A Quick look at MCL Injuries

An MCL or medial collateral ligament injury can be very painful. The MCL is responsible for stabilization, along with the anterior and posterior cruciate ligaments and the lateral collateral ligament, for the stabilization of the knee joint. The MCL runs from the end of the thigh bone to the top of the shinbone on the inside of the knee. The medial collateral ligament is responsible for keeping the inside of the knee joint from opening too far. An injury, whether a sprain or a tear typically happens from a blow to the opposite side of the knee, causing the joint to open, stretching the ligament. This stretching can result in swelling of the MCL or even a tear in its fibers. Often a MCL injury is accompanied with injuries to the other ligaments of the knee joint.

Could You Have Played Jay?

This is a great question. If you think about it, the MCL is crucial to stability of the knee joint. A quarterback has to have a good plant to be effective. Lose that stability and the ability to plant your feet and a quarterback can lose his effectiveness. Just the pain of the injury alone can cause a person to lose focus. Don't know if I would want the fortunes of my beloved Cleveland Brownies riding on that instability.

How Bad Was It Drew?

The news is that Drew Brees of the New Orleans saints played for six weeks of the season with a MCL injury. In an interview with Chris Chase of the blog Shutdown Corner, Brees handled the Cutler question with class. Brees rightly pointed out that there are varying degrees of MCL injuries and the healing process can be different for each. Drew is right. A MCL injury can be a Grade I MCL tear. A Grade I will result in an incomplete tear with a small amount of pain and swelling. A Grade II Tear, also an incomplete tear of the ligament will have the patient complaining of instability of the joint and a significant amount of pain and swelling. A Grade III MCL Tear is a complete tearing of the ligament accompanied by an inability to bend the knee. Usually someone with a Grade III MCL tear will also complain of not being able to bear weight on the injured leg.

The Road Back

Medial collateral ligament injuries usually not career threatening. Initial care involves icing down the injury area and immobilization of the joint. An anti-inflammatory medication and taking weight off the injured knee are also initial treatments. After an MRI to determine the extent of the damage, further treatment can be in order. For a Grade I tear, this treatment is all that is needed for 1-2 weeks. An athlete can usually get back in the game after this time period and like Drew Brees, they might even possibly play on the injured knee even though they might suffer further damage.

With a Grade II MCL Tear, treatment usually involves a hinged knee brace and physical therapy. Return to play can be accomplished in 3-4 weeks.

An athlete, or anyone for that matter, who suffers a Grade III MCL tear will usually have to wear a knee immobilizer and use crutches for 1-2 weeks. Following this initial period, a hinged knee brace along with progressively harder physical therapy is indicated with a healing time of 3-4 months.

Surgery is usually not performed on a medial collateral tear. Doctors and athletic trainers are happy to let a MCL injury heal on its own. Surgery is reserved for when there isalso damage to the other knee ligaments.

You see Jay, the injury and rehab process is not so bad but how to heal that reputation? I would suggest a good spin doctor.

Ray Mickol is a medical educator living in Cleveland, Ohio. He teaches at the Cleveland Clinic and MetroHealth Medical Center, one of the nation's busiest trauma centers.

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