What is the treatment for a Medial Collateral Ligament (MCL) sprain?

Treatment of MCL Sprain

Most MCL sprains (grades I, II, and even isolated grade III) should be treated non-operatively with functional rehabilitation, avoiding immobilization beyond 10 days, and reserving surgery only for combined ligament injuries or chronic cases that fail conservative management.

Initial Management (First 10 Days)

• Use NSAIDs for short-term pain relief (less than 14 days) to control pain and swelling without significantly increasing adverse events 1
• Apply functional support with a semirigid brace rather than elastic bandages, as semirigid supports are more effective 1
• Avoid prolonged immobilization beyond 10 days, as this leads to worse functional outcomes 1
• Do not rely on RICE protocol alone, as evidence shows it has no positive influence on pain, swelling, or function 1
• A brief period of lightweight support (less than 10 days) may help decrease initial pain and edema 2

Functional Rehabilitation (After Initial Phase)

• Begin supervised exercise therapy immediately after the initial pain control phase, focusing on range of motion first, then progressing to strengthening 1
• Prioritize exercises targeting proprioception, strength, coordination, and function, as these lead to faster recovery and return to activities 1
• Continue functional support (bracing) for 4-6 weeks during the rehabilitation period 1
• Early functional rehabilitation programs are the cornerstone of treatment for isolated MCL injuries 2

Grade-Specific Treatment Approach

Grade I and II MCL Sprains

• Treat non-operatively with functional rehabilitation as these injuries respond well to conservative management 3, 2, 4
• Expect good recovery of integrity and function with non-operative treatment 4

Grade III (Complete) MCL Tears

• Isolated grade III tears can be treated non-operatively, but only after careful exclusion of associated injuries requiring surgery 3, 4
• Expect slightly less successful results compared to grade I/II injuries when treated conservatively 4
• In combined ACL/MCL tears, non-surgical treatment of the MCL results in good patient outcomes, with surgical treatment of the MCL considered only in select cases 1

Surgical Indications

Surgery is indicated only in specific circumstances:

• Combined ligament injuries (particularly MCL with ACL or PCL tears) where cruciate ligaments require reconstruction 3, 4
• Chronic MCL injuries refractory to conservative treatment after adequate trial of non-operative management 5, 3
• Proximal deep MCL tears in high-level athletes that fail to heal and cause persistent symptoms with external rotation testing 6
• Professional athletes requiring rapid return to play who have not responded to conservative treatment 1

The 80% incidence of concomitant ligament injury with grade III MCL tears makes thorough evaluation for associated injuries critical 4.

Common Pitfalls to Avoid

• Do not immobilize for extended periods, as this correlates with worse functional outcomes 1
• Do not use NSAIDs beyond 14 days, as they may delay natural healing since inflammation is necessary for tissue recovery 7
• Do not miss associated injuries, particularly ACL tears, which significantly influence prognosis and may require surgical intervention 3, 4
• Re-examine at 3-5 days post-injury when pain and swelling have improved to better assess ligament damage severity 1
• Recognize that proximal deep MCL tears in high-level athletes may require surgical repair if conservative treatment fails after 10+ weeks 6

Return to Sport

• Use supervised exercises focusing on proprioception, strength, coordination, and function when returning to sports 1
• Implement immediate functional treatment with a return-to-sport schedule to minimize absence from activities 1
• Continue functional support devices during high-risk activities, particularly for patients with history of recurrent sprains 8