Hinged Knee Brace for MCL Injury
For an MCL injury, use a functional knee brace with unilateral or bilateral hinged bars, selecting the longest brace that fits the patient's leg to maximize MCL protection. 1
Specific Brace Type and Design
- A functional knee brace with hinged bars (either unilateral or bilateral) is the recommended brace type for mild to moderate MCL instability 2, 1
- The "hinge-post-shell" or "hinge-post-strap" design is most appropriate for MCL injuries 1
- Off-the-shelf braces are generally sufficient for most MCL injuries and are more cost-effective than custom braces, which provide few additional benefits 2, 1
Range of Motion Settings
- For moderate-to-severe MCL injuries (Grade II-III), set the brace to restrict motion from 30-90 degrees of flexion for the first 6 weeks 3
- A recent 2025 randomized trial found that the 30-90 degree restricted brace group trended toward better adherence, satisfaction, function, and quality of life compared to a 0-90 degree protected brace 3
- At 12 weeks, 82% of patients in the restricted (30-90 degree) group achieved less than 1mm side-to-side valgus laxity difference, compared to 67% in the protected group 3
Brace Fitting Requirements
- Select the longest brace that comfortably fits the patient's leg, as shorter braces provide significantly less MCL protection 2, 1
- Correct placement of hinges relative to the femoral condyles is essential for optimal brace performance and to minimize range of motion limitations 2, 1
- Regular tightening of straps, tape, or hook-and-pile fasteners is necessary to reduce unwanted brace migration 2, 1
- Daily assessment of brace positioning and structural integrity is required; damaged braces must be replaced 2, 1
Duration of Brace Wear
- Constant brace wearing for 4 weeks, followed by daytime wear until 6 weeks post-injury 3
- Early functional rehabilitation with lateral hinged bracing (allowing flexion/extension while providing valgus support) produces comparable results to surgery or immobilization while allowing more rapid return to sports 4
Critical Caveat About Bracing Grade II Injuries
Not all Grade II MCL injuries require bracing. A 2019 prospective study of 130 MCL injuries in professional football players found that using a stabilizing knee brace in Grade II MCL injuries was associated with a longer lay-off period (41.5 days vs. 31.5 days without brace, p=0.010) 5. This suggests that routine bracing may not be necessary in milder Grade II cases and could potentially delay return to play 5.
Essential Adjunctive Treatment
- Bracing must be combined with appropriate rehabilitation exercises starting at 2 weeks for optimal outcomes 1, 3
- Strength training, conditioning, technique refinement, and flexibility are more important than bracing alone in MCL injury management 2, 1
- Range of motion exercises should be initiated early, performed in a whirlpool or swimming pool, followed by quadriceps setting and leg raises 4
- When 90 degrees of flexion is achieved, add resistive exercises 4