From the Guidelines
An MCL sprain is treated primarily with rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours after injury, although the provided evidence does not directly support this for MCL sprains, it is a common practice in treating ligament sprains 1.
Treatment Approach
The treatment approach for an MCL sprain involves a combination of conservative management and rehabilitation.
- Take over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) as needed for pain and inflammation.
- Most MCL sprains heal without surgery in 2-8 weeks depending on severity.
- Use a knee brace for support during recovery, particularly one that provides medial support.
- Begin gentle range-of-motion exercises after the acute pain subsides, followed by progressive strengthening exercises focusing on the quadriceps and hamstrings.
Rehabilitation and Prevention
- Avoid activities that cause pain or put stress on the inner knee.
- Physical therapy is recommended for moderate to severe sprains to ensure proper rehabilitation.
- The MCL connects the femur to the tibia on the inner side of the knee and provides stability against forces that push the knee outward.
- Proper healing is important to prevent chronic instability and increased risk of future injuries.
- Seek medical attention if you experience severe pain, inability to bear weight, or if symptoms don't improve within a week.
Evidence Limitations
It's worth noting that the provided evidence primarily focuses on ankle sprains rather than MCL sprains, which may limit its direct applicability to the treatment of MCL sprains 1. However, the general principles of treating ligament sprains can be applied, with a focus on conservative management, rehabilitation, and prevention of future injuries.
From the Research
MCL Sprain Overview
- The medial collateral ligament (MCL) is a major stabilizer of the knee joint and is the most common ligament injured in the knee, particularly in athletes 2.
- MCL injuries can result from both contact and noncontact sporting activities 3.
- The MCL has a complex, layered anatomy with multiple insertions and functions, and minor trauma can cause tearing of the superficial portion whereas higher energy mechanisms can disrupt both the deep and superficial layers 2.
Diagnosis and Treatment
- History and physical examination are often adequate for diagnosis, but the gold standard for diagnosis is MRI 2.
- Lesser injuries to the MCL can often be treated conservatively with early rehabilitation, but more significant tears often necessitate surgery 2.
- Conservative management is usually recommended for grade I and II tears, while grade III tears may require surgical intervention, especially if associated with injuries to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) 4.
- Surgical techniques for MCL injuries include primary repair, augmented repair with autograft tissue, or primary reconstruction 5.
Combined ACL and MCL Injuries
- Combined injury of the ACL and MCL is a common injury pattern, accounting for 20% of all ligamentous knee injuries 6.
- There is no consensus on the superiority of nonoperative versus operative management in higher-grade MCL tears of combined ACL-MCL injuries 6.
- A systematic review and meta-analysis found no statistical difference between nonoperative versus surgically managed MCL injuries for patient-reported outcomes, range of motion, or quadriceps strength 6.
- Reconstruction of combined injury in a delayed fashion may facilitate return of range of motion and allow time for low-grade MCL tears to heal 6.