Emerging Manchester United midfielder Scott Mctominay suffered right knee ligament damage in the 2nd minute of the team’s boxing day match vs Newcastle United. Mctominay continued to play through the knock for the remainder of the first half but was replaced by Paul Pogba at halftime.
In this article, I’ll explain the injury, Mctominay’s return to play timeline & rehab process, and key concerns moving forward. If you prefer a video format, I’ve got you covered!
The injury
Anatomy
The knee joint – medically known as the tibio-femoral joint has four major stabilizing ligaments:
The anterior cruciate ligament (ACL), the lateral collateral ligament (LCL), the posterior cruciate ligament (PCL), and medial collateral ligament (MCL).
These ligaments can be thought of as rubber bands that are tensioned and stretched to keep a joint within its normal range of motion with each coming under varying degrees of stress depending on the specific motion at the knee joint. If the joint is placed under excess stress than a ligament can handle, the ligament is overstretched and possibly torn.
In Mctominay’s case, that excess stress resulted from a 2nd minute collision with Newcastle United mid Matty Longstaff.
Severity
Knee ligament sprains/tears are categorized into three grades.
A grade I involves stretching and microscopic tearing of the ligaments with mild swelling and tenderness, no joint instability, and ability to bear weight and walk with minimal pain.
A grade II is an incomplete tear of the ligament with moderate pain, swelling and bruising, mild to moderate joint instability and deficits in range of motion and function upon examination, with difficulty bearing weight and walking.
A grade III is a complete tear – aka a rupture – with severe pain, swelling and bruising, significant instability and deficits in range of motion and functionality upon exam, with significant difficulty bearing weight and walking.
Getting back to the pitch
Return to play (RTP)
The return to play timeline depends on the specific severity and specific ligament or ligaments injured. Manchester United haven’t given specifics on Mctominay’s injury but we do have two major indicators to develop a hypothesis.
The first is the fact that Mctominay was seen leaving the ground on crutches in a brace. This difficulty with weight-bearing and walking hints at a grade II or higher injury.
The second indicator comes via reported timeline. Originally, Man United manager Ole Gunnar Solskjaer reported that Scott may be out around “three to four weeks” but recent reports indicate that timeline may actually be upwards of eight weeks with an MRI revealing more damage than initially expected.
Potential injury and timeline
I couldn’t find a good angled video of the injury but it was reported that Mctominay was injured specifically during a block tackle on Matty Longstaff. Based on that purported mechanism of injury, reported timeline, and overall prevalence of specific ligament injuries in football, Mctominay may have a grade III MCL rupture (full tear) which averages a seven week return to play timeline. The MCL is very well vascularized – meaning it has great blood flow – so it can heal quite well on its own without the need for surgery.
Rehab
Regardless of the specific injury, Mctominay’s rehab will focus on reducing pain and restoring normal knee range of motion while incrementally progressing strengthening and proprioception.
Prior to graduating to higher intensity training, he’ll be put through multiple single leg tests that compare side to side strength, mobility, and neuromuscular symmetry with significant differences being a key indicator for lower extremity injury risk.
Eventually he’ll progress back to limited training, full practice, and then be reintroduced into games.
Three concerns
Not coming off immediately
The fact that Mctominay played 43+ mins after the injury rather than coming off immediately – although not that uncommon with lower grade ligament injuries – may have played a role in worsening his injury because he continued to stress already damaged anatomy.
Persistent laxity
Research shows that knee ligament injuries – even relatively mild grade I damage – may result in increased laxity (looseness) in the knee with potential feelings of instability. To combat that, Mctominay and the Man United training staff will focus on comprehensive knee strengthening in the short and long-term.
Fluctuating fitness levels
My biggest concern with Mctominay is that this is now his second major injury of the season in relatively quick succession, having just missed nearly a month with ankle ligament damage.
These long spells off can result in a yo-yo of fitness and rhythm, with the player constantly trying to play catch-up because it’s nearly impossible to replicate in-game fitness off the field. These significant changes in activity quantity and intensity can lead to increased risk for soft tissue injuries (muscles, ligaments, tendons, bones, etc), especially as Scott begins to ramp up training in preparation for returning to the pitch and then gets back to games. Case in point is Paul Pogba’s ongoing struggle with fitness and health. Accordingly, Mctominay will need an even keener eye and daily monitoring as he makes his way back to avoid those same pitfalls.
That’s a wrap for this article. Thanks for reading. My goal is to provide you with in-depth, evidence based, narrative free analysis and you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the blog, YouTube channel, and follow along on all social media for the latest updates. 3CB out.