Knee Brace Recommendation for Suspected Grade 2 MCL Tear
For a suspected grade 2 MCL tear, use a functional knee brace with hinged bars (either unilateral or bilateral) for 4-6 weeks, selecting the longest brace that comfortably fits the leg. 1
Brace Type and Design
- A functional knee brace with hinged bars is the recommended brace type for mild to moderate MCL instability, which includes grade 2 tears 2, 1
- Choose either a "hinge-post-shell" or "hinge-post-strap" design, with the hinge-post-shell design providing better tibial-displacement control, greater rigidity, and enhanced durability 2, 1
- Off-the-shelf (presized) braces are generally sufficient and preferable when cost or rapid availability is important, as they provide comparable outcomes to custom braces 1
Brace Selection and Fitting
- Select the longest brace that comfortably fits the patient's leg, as shorter braces provide less MCL protection 2, 1
- Ensure correct hinge placement relative to the femoral condyles for optimal brace performance 2, 1
- Regular tightening of straps or fasteners is essential to reduce unwanted brace migration 2, 1
- Size presized braces by measuring thigh circumference 6 inches above the mid-patella 2
Duration of Brace Use
- Brace use for 4 weeks is standard based on clinical practice, with one case series reporting protective bracing postoperatively for this duration 3
- However, recent evidence from professional football players suggests that bracing for grade 2 MCL injuries may not always be necessary and was associated with longer recovery times (41.5 days with brace vs. 31.5 days without brace) 4
- This finding indicates that routine bracing should not be mandatory in milder grade 2 cases, and the decision should be based on clinical stability and patient symptoms 4
Critical Caveats
- Bracing alone is insufficient—it must be combined with appropriate rehabilitation exercises, as strength training, conditioning, and flexibility are more important than bracing alone in MCL injury management 2, 1
- Subjective benefits of bracing often exceed objective findings, with brace effectiveness limited at physiologic stress levels 2, 1
- Regularly assess brace positioning and structural integrity; replace damaged braces immediately 2, 1
- Watch for failure of conservative treatment: persistent tenderness at the proximal MCL attachment site that can be precipitated by rapid external rotation may indicate a problematic subgroup requiring surgical repair 5
- If combined with ACL or PCL tears, the MCL component can typically still be treated non-surgically with bracing 6
When to Consider Alternatives
- Grade 2 tears without significant instability on examination may not require bracing at all, particularly in lower-demand patients 4
- Setting 10 to 20 degrees of extension limitation may help minimize hyperextension 2
- If symptoms persist beyond 6-8 weeks despite appropriate bracing and rehabilitation, consider MRI evaluation to rule out intra-articular entrapment or other complications requiring surgical intervention 5, 7