What is the treatment for a grade 2 Medial Collateral Ligament (MCL) tear?

Treatment of Grade 2 MCL Tear

Non-surgical treatment is the recommended approach for grade 2 MCL tears, focusing on rehabilitation and protected weight-bearing to promote healing and restore function. 1, 2

Initial Management

• Grade 2 MCL tears (partial tears with some instability) respond well to conservative treatment with early functional rehabilitation 2
• Consider aspiration of painful, tense knee effusions after injury to provide symptomatic relief 1
• Protected weight-bearing with crutches may be necessary initially until pain and swelling subside 3

Bracing Protocol

• Functional knee bracing is indicated during the healing phase to protect the MCL while allowing controlled motion 2
• Bracing typically lasts 4-6 weeks depending on healing progress and stability assessment 3
• Prophylactic bracing is not recommended for prevention of future injuries 1

Rehabilitation Program

• Early range of motion exercises should be initiated to prevent stiffness 2
• Progressive strengthening of quadriceps and hamstrings should begin as soon as tolerated 3
• Supervised rehabilitation program is preferred over self-directed exercise for optimal outcomes 1

Return to Activity

• Gradual return to activities based on functional progress, typically 4-8 weeks for grade 2 tears 2
• Functional evaluation tests (such as hop tests) may be used to determine readiness for return to sports 1
• Return to cutting and pivoting sports should be delayed until full stability is restored 1

Surgical Considerations

• Surgery is rarely indicated for isolated grade 2 MCL tears 2
• Surgical intervention may be considered only if:
  • Conservative treatment fails after an appropriate trial (persistent instability) 2
  • There are associated injuries requiring surgical management (such as ACL tears) 1
  • There is entrapment of the MCL over the pes anserinus 2

Special Considerations

• In cases of combined ACL and MCL injuries, non-surgical treatment of the MCL component still produces good outcomes while the ACL may require reconstruction 1
• Proximal deep MCL tears may represent a subgroup that responds less favorably to conservative treatment and might require surgical intervention if symptoms persist 4
• Chronic, unhealed MCL injuries with persistent instability may eventually require surgical reconstruction 2

Monitoring and Follow-up

• Regular clinical assessment of stability and healing progress is essential 3
• Persistent medial joint line tenderness beyond 6-8 weeks may indicate incomplete healing 4
• Long-term monitoring is important as failure of proper healing can lead to chronic instability, weakness, and potentially osteoarthritis 2