MCL Injury – Medial Collateral Ligament – Physiotherapy

By Dr Daniel Meyerkort, Knee Surgeon, Perth Orthopaedic & Sports Medicine Centre

Overview of MCL injury

The MCL is a broad ligament on the inner aspect of the knee. It is commonly injured in twisting knee injury. Various degrees of MCL injury can occur from a partial sprain to complete rupture of the ligament. Most MCL injuries will heal well with a hinged knee brace and Physiotherapy.

Diagnosis of MCL injury

Patients with MCL injury are tender over the inner aspect of the knee. With complete rupture, the inner aspect of the knee may open under stress. The best imaging modality to diagnose MCL injury is an MRI scan.

Treatment of MCL injury

A low grade, partial sprain (Grade 1 injury) can start immediate Physiotherapy as pain allows (knee range of motion and muscle strengthening.) Higher grade injury (Grade 2/3 or complete rupture) requires bracing in a hinged knee brace to allow the ligament to heal. Patients can weight bear as tolerated while in the brace for a 6 week period. Surgery may be required for tibial side avulsions and combined injury (eg MCL + ACL or meniscus injury).

Physiotherapy for MCL injury

Low grade sprains (grade 1 injury) can start immediate range of motion and muscle strengthening as tolerated. Higher grade injury and complete rupture (grade 2/3 injury) requires 6 weeks in a hinged knee brace. According to the degree of injury, motion is allowed with the brace on and your Physiotherapist can guide you in regaining knee motion. The brace is removed from week 6 and rehabilitation is progressed with range of motion and muscle strengthening exercise.

Surgery for MCL injury

Surgery is rarely required for an isolated, femoral sided MCL injury, even with complete avulsion or rupture. Surgery may be required for:

  • Tibial sided MCL avulsion due to the higher rate of ongoing instability

  • Combined MCL / ACL injury

  • Combined MCL / meniscus injury