Management of Isolated Grade 1 MCL Sprain
Apply a semirigid or lace-up brace immediately and begin early functional rehabilitation with protected weight-bearing—avoid rigid immobilization or elastic bandages, as they lead to inferior outcomes. 1
Immediate Management (First 10 Days)
- Use a semirigid or lace-up brace from the outset rather than elastic compression bandages, as this provides superior functional support while allowing protected knee movement 1
- Implement the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) to control pain and swelling immediately after injury 2
- Limit any immobilization to ≤10 days maximum, using it only for pain or edema control, then transition promptly to functional rehabilitation 1
- Never use rigid immobilization or casting, as these result in significantly poorer functional recovery compared with early mobilization 1
Pain Management
- Prescribe oral or topical NSAIDs for pain control, using the lowest effective dose for the shortest duration 3
- Consider aspiration of tense, painful knee effusions for symptomatic relief if present 2
Rehabilitation Protocol
- Add manual joint mobilization to the exercise program, as this combination yields better short-term pain relief and greater range of motion than exercise alone 1
- Begin aggressive early functional rehabilitation with supervised physical therapy focusing on quadriceps strengthening, range of motion exercises, and functional activities 3, 2
- Continue the semirigid or lace-up brace for 4–6 weeks during all activities to maintain joint stability while the ligament heals 1
Key Clinical Pitfalls to Avoid
- Do not rely solely on compression bandages, as they offer inadequate support compared with semirigid braces 1
- Avoid prophylactic knee bracing for injury prevention, as evidence of effectiveness is limited and braces may actually increase forces on the medial knee 3, 2
- Do not rush return to activity—use functional evaluation rather than time-based protocols alone to guide return to sport decisions, as premature return can lead to chronic problems including decreased range of motion, pain, and joint instability 2