Messi’s messy medial collateral ligament (MCL) tear

It’s time to play the game of 2 truths and 1 lie! Can you pick out which of these statements about me is false?

  1. I scored 32 points in a junior high basketball game but now cannot do a lay-up to save my life.
  2. I made an appearance on the Ellen Show.
  3. I hate sports and I would much rather watch the Real Housewives of Atlanta.

If you chose statement 3, you are correct! My basketball career peaked when I was going through puberty and I love (stalking) Ellen Degeneres.

Plus, everyone knows that I am a MASSIVE sports fan! And as much as I love the NFL, I thought I’d expand my horizons and start blogging about sport injuries in general. Don’t worry football fans, there’s still many football posts to come. But today, the spotlight is on this guy:hi-res-6927654_crop_north

Lionel Messi! If you looked up “Messi” in Webster’s dictionary, you would find “the world’s best soccer player” beside it. (Sorry not sorry, Cristiano Ronaldo.) Messi is a human highlight reel. Please take the next few minutes soaking up some wicked Messi talent.

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homer-simpson-drooling-a-887x1024Whoops, I think I fried my keyboard with drool. After watching those videos, it’s understandable if you think Messi is some sort of wizard. But the truth is that Messi is a mere muggle like the rest of us! He’s like any other player in that he’s picked up some knocks in the past. A broken metatarsal, a quad strain, and a couple of hamstring strains have forced Messi out of action for a combined 47 games in his career.

And unfortunately for Messi that number is growing. Saturday’s league match against Las Palmas got a little messy for Messi. As he was attempting to make a pass, he was kicked in the ankle by his opponent. Here’s the video. Fast forward to 1:28 for the replays and watch his left leg carefully.

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From the video, you can see the defender makes contact with the inside of Messi’s ankle when he’s kicking the ball. This impact on his ankle forces his knee into valgus (knee caves to the inside) and causes excessive stress on the medial (inner) aspect of his knee. That quick blow to the lower leg lead to Messi injuring his medial collateral ligament (MCL). Bummer, man…

The MCL is one of four ligaments that provide stability to the knee. It can be found along the inner portion of the knee. Its job is to restrict valgus and external rotation forces at the knee.

Here’s where things get a bit complicated. The MCL actually consists of 3 different components and is therefore more accurately referred to as the “MCL complex”. Let me provide you with an analogy of these parts to clear up the confusion:

  1. Superficial MCL = the primary static stabilizer of the medial side of the knee!3 It limits valgus force in 15o, 30o, 60o, and 90o of knee flexion but not in extension.1 The superficial MCL is like Beyoncé – it is the queen bae of knee stability. Surfboard.
  2. Deep MCL = the secondary static stabilizer of the medial side of the knee. A portion of the deep MCL helps with stability.1 The deep MCL is like Kelly Rowland – it supports the main act.
  3. Posterior oblique ligament (POL) = the extension of the superior MCL that blends into the joint capsule. It does not play a role in static stability but helps out in dynamic stability.1 The POL is like Michelle Williams – it does what it can to contribute but mostly blends into the background.

Screen Shot 2015-09-30 at 12.01.50 AMThe bad news? According to the reports, Messi suffered a complete tear of his MCL complex. This means there was damage to all 3 components.

The good news? The superficial MCL can heal itself! They didn’t put “super” in superficial for nothing! Although healing is observed after several weeks, microscopic tissue remodeling can go on for a year.1 So even though Messi’s knee will feel stable after a few weeks, the ligament won’t be completely done its healing process until next year.

Screen Shot 2015-09-30 at 12.13.10 AMThe great news? The MCL complex is bolstered by muscles! In extension, the superficial MCL is supported by the vastus medialis (inner quad muscle). In flexion, both the superficial MCL and the POL are supported by the semimembranosus (inner hamstring muscle).1 Strong muscles offer support for the knee. And the more knee support there is, the better the chances are for returning to sport. And look at the beautiful leg muscles on this guy!

The best news? The majority of isolated MCL tears heal well without needing surgery. Messi would have started off using crutches and wearing a hinged knee brace to encourage the torn ends of the ligament to unite. And despite being in a brace, his physio would have instructed him to keep his knee moving in pain-free range of motion. Early mobilization and progressive strengthening has lead to excellent results for ligament healing as well as successful return to sport!3

Messi’s initial rehab will consist of range of motion, weight bearing, and strengthening exercises. Throughout the weeks, he will progress through various agility, cutting and pivoting, jumping, and kicking drills. destinys-childIf all goes well, we should see him back on the pitch in 6-8 weeks – hopefully without having lost a stride!

Good luck, Leo! And to quote the great Destiny’s Child once said, “You’re a survivor, you’re not gon give up, you’re not gon stop, you’re gon work harder.” Channel that inner survivor!

– Chris (0-3)156201_907960274375_1899945006_n

P.S. Here’s something for all you die hard NFL fans who didn’t get their football fix. Ben Roethlisberger, quarterback of the Pittsburgh Steelers, also suffered the same injury on Sunday. All the same principles apply but expect Big Ben to return to football faster (3-4 weeks) than Messi to soccer because he doesn’t need to kick anything!br.0


References:

  1. Marchant Jr, M.H., Tibor, L.M., Sekiya, J.K., Hardaker Jr, W.T., Garrett Jr, W.E., & Taylor, D.C. (2011). Management of medial-sided knee injuries, part 1. The American Journal of Sports Medicine, 39(5), 1102-1113.
  2. Miyamoto, R.G., Bosco, J.A., & Sherman, O.H. (2009). Treatment of medial collateral ligament injuries. Journal of the American Academy of Orthopaedic Surgeons, 17, 152-161.
  3. Phisitkul, P., James, S.L., Wolf, B.R., & Amendola, A. (2006). MCL injuries of the knee: current concepts review. The Iowa Orthopaedic Journal, 26, 77-90.

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