Treatment of MCL Strain
Non-surgical treatment with rehabilitation and protected weight-bearing is the recommended approach for grade 2 MCL tears. 1
Initial Management
- Apply RICE protocol (Rest, Ice, Compression, Elevation) immediately after injury to reduce pain and swelling 2
- Consider aspiration of painful, tense knee effusions after injury to provide symptomatic relief 3, 1
- Lightweight support with bracing to protect the MCL during healing while allowing controlled motion 2, 4
Bracing Protocol
- Use a hinged knee brace that provides valgus support without restricting knee flexion or extension 4
- Brace should be worn during the initial healing phase (typically 4-6 weeks depending on injury severity) 4
- Prophylactic bracing is not recommended for prevention of future injuries 3, 1
Rehabilitation Program
- Begin with early functional rehabilitation rather than immobilization 4
- Start with gentle range of motion exercises performed in a whirlpool or swimming pool 4
- Progress to quadriceps setting exercises and leg raises once tolerated 4
- Add resistive exercises when 90 degrees of knee flexion is achieved 4
- A supervised rehabilitation program is preferred over self-directed exercise for optimal outcomes 1
Return to Activity Progression
- Functional evaluation tests, such as hop tests, may be used to determine readiness for return to sports 3, 1
- Return to cutting and pivoting sports should be delayed until full stability is restored 1
- Athletes can typically return to unrestricted sports when they have:
- Full range of motion
- No pain with activity
- Restored strength (compared to uninjured side)
- Completed sport-specific functional testing 4
Special Considerations
- Most isolated MCL injuries heal well with conservative treatment 5, 6
- 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 3, 1
- A small subgroup of proximal deep MCL injuries may be refractory to conservative treatment and require surgical repair, particularly in high-level athletes with persistent symptoms 5
- Grade III MCL tears (complete tears) may require longer rehabilitation periods but can still be managed non-operatively in most isolated cases 7, 4
Expected Outcomes
- With proper rehabilitation, athletes with isolated MCL injuries can expect excellent long-term outcomes 4
- Five-year follow-up studies show comparable results between non-operative treatment and surgical intervention for isolated MCL injuries, with the benefit of avoiding surgery-related complications 4
- Early functional rehabilitation allows more rapid return to sports participation compared to immobilization 4