From the Guidelines
Management of a medial collateral ligament (MCL) sprain typically involves conservative treatment rather than surgery, with a focus on functional support and exercise therapy to promote proper ligament healing and prevent muscle atrophy and joint stiffness. The most recent and highest quality study 1 recommends against the use of the RICE protocol as a treatment modality after a lateral ankle sprain, and instead suggests the use of functional support, such as a brace, to provide stability while allowing controlled motion.
Key Components of Management
- Functional support: a hinged knee brace is recommended for grade II and III sprains to provide stability while allowing controlled motion 1
- Exercise therapy: should be started as soon as possible to recover joint functionality, focusing on maintaining range of motion, then progressing to strengthening exercises for the quadriceps, hamstrings, and hip muscles 1
- Pain control: NSAIDs such as ibuprofen or naproxen may be used to reduce pain and swelling, unless contraindicated 1
- Progressive rehabilitation: essential to promote proper ligament healing while preventing muscle atrophy and joint stiffness
Return to Activities
- Most patients can return to normal activities within 2-6 weeks for grade I sprains, 6-8 weeks for grade II, and 8-12 weeks for grade III
- Return to sports requires full range of motion, at least 90% strength compared to the uninjured leg, and ability to perform sport-specific movements without pain
Surgery
- Surgery is rarely needed for isolated MCL injuries, as the ligament has excellent healing potential due to its good blood supply 1
From the Research
Management of MCL Sprain
The management of medial collateral ligament (MCL) sprains can be conservative or surgical, depending on the severity of the injury.
- Conservative management is often adequate for lesser injuries, with early rehabilitation being a key component 2, 3.
- Surgical management may be necessary for more significant tears, particularly those with valgus instability or failure of non-surgical treatment 4.
Indications for Surgical Management
Surgical management is indicated in certain cases, including:
- Isolated grade III tears with severe valgus alignment, MCL entrapment over pes anserinus, or intra-articular or bony avulsion 4.
- Failure of non-surgical treatment, which can result in debilitating, persistent medial instability, secondary dysfunction of the anterior cruciate ligament, weakness, and osteoarthritis 4.
Conservative Management
Conservative management typically involves early functional rehabilitation, which can be effective in returning patients to their prior level of function 4, 3.
- Prolotherapy, which involves injections of 15% dextrose combined with 0.2% lidocaine, has been shown to be effective in treating refractory tendinopathies, but its use in treating MCL injuries is not well established 5.
Timing of Surgical Management
The timing of surgical management is important, with primary repair of the MCL usually performed within 7 to 10 days after the injury 4.
- Augmentation repair for the superficial MCL (sMCL) is a surgical technique that can be used when the resulting quality of the native ligament makes primary repair impossible 4.
- Reconstruction is indicated when MCL injuries fail to heal in neutral or varus alignment, or when chronic instability is present 4, 6.