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

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.

<p>Epidemiological Data on LCL and PCL Injuries Over 17 Seasons in Men’s Professional Soccer: The UEFA Elite Club Injury Study</p>

“…Future studies are warranted to also examine the accuracy of the diagnosis of LCL and PCL injuries among medical teams in men's professional football, as previously has been done for MCL injuries. 13 The injuries reported in this study were cases in which LCL or PCL injury was reported as the main diagnosis, ie, more LCL and PCL injuries may have occurred during the 17 seasons, with these injuries reported as concomitant injuries. Moreover, it is unknown how potentially concomitant injuries to the LCL or PCL injuries might have affected the outcome, since it is possible that players who sustained an LCL or PCL injury may have associated injuries in terms of meniscal or cartilage injuries.…”

“…In most cases, the LCL and PCL injuries occurred predominantly during contact with another player or object, as has been described previously for MCL injuries. 13,14 Being tackled was the cause of approximately a quarter of the LCL injuries, while the most common contact mechanism for PCL was being kicked by another player. A contact mechanism as the most common cause of injury is different from ACL, where a non-contact mechanism is the most common.…”

“…Previous studies from the Union of European Football Associations (UEFA) Elite Club Injury Study have reported on ACL injuries [8][9][10][11][12] and on medial collateral ligament (MCL) injuries. 13,14 It has been reported that an MCL injury is around four times more common than an ACL injury in these studies and that MCL injuries involve a considerably higher percentage of contact-related injury mechanisms. So far, there are no similar reports of injuries to the lateral collateral ligament (LCL) and posterior cruciate ligament (PCL).…”

“…In contrast to the commonly seen isolated MCL injuries, 13,14 an injury to the lateral side of the knee usually involves not only the LCL but also damage to multiple structures. 20 Isolated injuries to the LCL usually involve a lower magnitude of trauma, resulting in a less severe injury to the ligament, while more severe LCL injuries usually require a higher magnitude of force.…”

Frequency of Different Ligament Tears in Knee Injury On Magnetic Resonance Imaging

“…The results are also compared with the study performed by Lundblad et.al which showed that they had taken 4364 football players from 51 teams. Out of these players 130(3%) presented with MCL injuries 16 .…”