Nonsurgical management for medial collateral ligament (MCL) sprain
Discuss the natural history of MCL sprain with the person, including their concerns, goals and expectations, and a proposed management plan including self-management.
Advise people there are choices in the management of MCL tears, usually dependent on the grade of the sprain (or tear).
Management for isolated grade 1 or 2 MCL sprain typically is nonsurgical. Initial management (including first aid) involves the POLICE regimen1 and analgesia; see Subacute management for soft-tissue limb conditions.
If analgesia is required, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered; see Analgesia for soft-tissue limb conditions.
For isolated grade 1 MCL sprains, walking (including weight bearing) is usually possible from the time of injury and initial symptomatic management is appropriate. People usually return to normal activities within 2 weeks.
For isolated grade 2 MCL sprains, in addition to symptomatic management, crutches may be required for a short period. Use of a hinged knee brace is recommended to prevent repeated valgus stress and reinjury. People usually return to normal activities within 4 weeks.
Several protocols for rehabilitation have been described for isolated grade 1 and 2 MCL sprains, with emphasis on maintaining quadriceps function and normalising range of motion of the knee. Activity is self-progressed as tolerated, with early weightbearing and gentle progressive quadriceps-strengthening exercises. After a grade 1 or 2 MCL sprain, return to normal levels of activity is usually encouraged once the person:
- is pain free with full range of motion
- has no instability of the knee on clinical examination
- has comparable muscle strength to the uninjured side.
Management options for grade 3 MCL tears are variable. A period of complete immobilisation is not recommended. Nonsurgical management has been shown to have good results using principles similar to those for grade 2 MCL sprains. This includes early range-of-motion exercises, use of a functional brace and a progressive physiotherapy program. A 2021 systematic review2 of randomised controlled trials indicated that nonsurgical management led to similar functional results for isolated grades 1 to 3 MCL sprainsRoberts, 2021.