From the Guidelines
For MCL injuries, treatment should focus on conservative management with the RICE protocol, pain management with over-the-counter medications, and supportive measures like knee braces, as there is limited evidence to support the use of prophylactic knee braces in preventing MCL injuries. When considering the use of knee braces for MCL injuries, it's essential to weigh the benefits and limitations, as noted in a study published in the American Family Physician 1. This study highlights that while some researchers believe prophylactic knee braces can reduce MCL injuries, others have found limited beneficial effects, and the braces may even generate increased forces that could worsen associated injuries to the medial knee. Key aspects of managing MCL injuries include:
- Rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours
- Over-the-counter pain medications like ibuprofen or naproxen for pain and inflammation management
- Use of a knee brace for support during the healing process, which can take 2-8 weeks depending on the severity of the injury
- Physical therapy exercises to improve range of motion, strength, and stability, starting once pain allows
- Gradual return to sports only when full strength and stability are restored, avoiding activities that cause pain. Given the current evidence, the focus should be on these conservative management strategies rather than relying on prophylactic knee braces for prevention, as supported by the study in the American Family Physician 1.
From the Research
MCL Injury Overview
- The medial collateral ligament (MCL) is a major stabilizer of the knee joint, providing support against rotatory and valgus forces 2.
- MCL injuries are common, particularly in athletes, and have been reported to be torn in 7.9% of all knee injuries 3.
- The increased participation in contact sports such as football, ice hockey, and skiing has contributed to the increased frequency of MCL injuries 4.
Causes and Diagnosis
- Most MCL injuries result from a valgus force on the knee 4.
- Minor trauma can cause tearing of the superficial portion of the MCL, whereas higher energy mechanisms can disrupt both the deep and superficial layers 3.
- History and physical examination are often adequate for diagnosis, but the gold standard for diagnosis is MRI 3.
Treatment Options
- Lesser injuries to the MCL can often be treated conservatively with early rehabilitation 3.
- More significant tears often necessitate surgery, especially those with combined ligamentous injuries 3, 4.
- Conservative management is usually recommended for grade I and II tears, while grade III tears may require operative treatment, especially if associated with injuries to other ligaments 5.
- Recent literature has suggested operative MCL management as a suitable option for specific patient populations 2.
Rehabilitation and Prevention
- Rehabilitation programs for conservative treatment of MCL injuries and postoperative programs after ligament reconstruction are essential for optimal recovery 5.
- Prophylactic knee bracing in contact sports may prevent MCL injuries, but may also affect performance 4.
- Accurate characterization of each aspect of the injury is necessary to determine the optimum treatment plan 4.