Medial Collateral Ligament Treatment

What is the treatment for a MCL tear?

Treatment of a medial collateral ligament injury rarely requires surgical intervention. Almost always, some simple treatment steps, along with rehabilitation, will allow patients to resume their previous level of activity. The time before an athlete is able to return to their sport corresponds to the grade of the injury.

Grade I MCL Tears

Grade I sprains of the MCL usually resolve within a few weeks. Treatment consists of:

• Resting from activity

• Icing the injury

• Anti-inflammatory medications

Most patients with a grade I MCL tear will be able to return to sports within 1-2 weeks following their injury.

Grade II MCL Tears

When a grade II MCL sprain occurs, use of a hinged knee brace is common in early treatment. Athletes with a grade II injury can return to activity once they are not having pain over the MCL. Patients with a grade II injury often return to sports within 3-4 weeks after their injury.

Grade III MCL Tears

When a grade III injury occurs, patients usually wear a knee immobilizer and protect weight-bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.

Once the patient can flex the knee at least to 100 degrees, they may begin riding a stationary bicycle. The crutches can be discontinued one the patient is able to walk without limping. Jogging can begin once the patient has regained 60% of their quadriceps strength (compared to the opposite side), and agility drills can begin one they have regained 80% of their strength. Complete rehab from a grade III MCL tear can take 3-4 months.

Is surgery ever needed for a MCL tear?
Some surgeons describe a so-called grade IV injury to the medial collateral ligament. This is also called a medial column injury, and involves injury to more ligaments than just the MCL. Whether or not to repair the MCL, even in these settings, is controversial. Some doctors prefer to allow all MCL injuries to heal without surgery, and some prefer to repair these most significant injuries to the MCL. No significant difference has been demonstrated in these patients.

References:

• Indelicato, PA. "Isolated Medial Collateral Ligament Injuries in the Knee" J. Am. Acad. Ortho. Surg., Jan 1995; 3: 9 - 14.