From the Guidelines
Management of a grade 2 MCL injury in a professional football player should prioritize a comprehensive rehabilitation protocol over prophylactic knee bracing, given the lack of sufficient evidence supporting the efficacy of knee braces in reducing the incidence or severity of ligamentous knee injuries, as noted in studies such as 1. The rehabilitation protocol should typically follow a return-to-play timeline of 2-4 weeks, focusing initially on controlling pain and swelling through PRICE principles (protection, rest, ice, compression, elevation) for the first 48-72 hours. Key aspects of the management include:
- Pain management with NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 5-7 days, with acetaminophen (1000mg every 6 hours) as needed, based on general medical knowledge and not specifically mentioned in the provided studies.
- Utilization of a hinged knee brace during the recovery period to provide medial support while allowing controlled movement, although the evidence from 1 and 1 suggests that prophylactic knee braces may offer limited benefits. The rehabilitation program should progress through phases:
- Early phase (days 1-7) emphasizing protected weight-bearing, gentle range of motion exercises, and quadriceps isometrics.
- Intermediate phase (days 7-14) introducing progressive strengthening, stationary biking, and straight-line jogging.
- Advanced phase (days 14+) incorporating sport-specific movements, cutting drills, and controlled contact situations, similar to the approach for other knee injuries discussed in 1. Functional testing should demonstrate symmetrical strength, full pain-free range of motion, and successful completion of sport-specific drills before return to competition, prioritizing the athlete's safety and the quality of life by minimizing the risk of further injury or long-term morbidity.
From the Research
Management of Grade 2 MCL Injuries
The management of a grade 2 Medial Collateral Ligament (MCL) injury in a professional football player typically involves conservative treatment approaches.
- Conservative treatment for grade 2 MCL injuries often includes a combination of rest, ice, compression, and elevation (RICE) during the initial 72 hours, followed by progressive loading exercises and rehabilitation programs 2.
- Positional release therapy (PRT) has also been used as an early intervention in the recovery process, aiming to release tension in the affected tissue and promote healing 2.
- The use of platelet-rich plasma (PRP) injections has been explored as a potential therapeutic option for treating high-grade MCL lesions, with some case reports suggesting promising results 3.
- However, the effectiveness of PRP injections for treating MCL injuries in humans is still lacking strong evidence and requires further investigation through high-quality randomized controlled trials 3.
Treatment Approaches and Outcomes
- Non-operative treatment is often recommended for grade 1 and 2 MCL injuries, as well as for grade 3 injuries without associated meniscal avulsion or other structural damage 4.
- The use of a stabilizing knee brace in players with grade 2 MCL injuries has been associated with a longer lay-off period compared to those who did not use a brace 5.
- Rehabilitation programs for MCL injuries typically involve progressive exercises, such as quadriceps engagement, single-leg squats, and functional movements, to restore strength, stability, and range of motion in the affected knee 2.
- The average return to sport time for grade 2 MCL injuries has been reported to be around 20 days, although expedited returns to sport have been achieved with early intervention and progressive rehabilitation programs 2, 5.