MCL Tear Treatment and Repair

The medial collateral ligament is the most frequently injured ligament in the knee and, fortunately, the one most likely to heal on its own. It runs along the inner side of the joint, it has a good blood supply, and most tears recover fully with bracing and rehabilitation rather than surgery.

Most MCL injuries heal without surgery, and identifying the ones that will not is where the evaluation earns its value. Steven Struhl, MD is board certified in orthopedic surgery and holds separate board certification in sports medicine, completed his fellowship training at Penn State University, and has served as medical director for Sportscare Physical Therapy, the practice treating the Brooklyn Nets.

How an MCL Tear Happens

A force driving the knee inward, opening the inner side of the joint. In sport that is usually a blow to the outside of the knee, which is why it is common in football, skiing, and hockey.

• Contact Injury: a direct blow to the outer knee, the classic mechanism.
• Skiing: the ski catching an edge and rotating the leg outward.
• Cutting And Pivoting: a valgus force during a change of direction.
• Combined With ACL: a common pairing, since the same force can tear both.

MCL Tear Grades and Symptoms

• Grade One: stretched fibers, with inner knee pain and tenderness but no laxity.
• Grade Two: partial tear, with some opening under stress and more pronounced pain.
• Grade Three: complete tear, with clear opening and a sense the knee is unstable sideways.
• Location Matters: tears near the femur heal better than tears at the tibial attachment.

That last point is one patients are rarely told and it genuinely affects the plan. MCL tears at the upper end, near the thigh bone, heal reliably. Tears at the lower end, near the shin bone, heal less predictably, partly because the torn end can displace where it cannot reach its attachment.

MCL Tear Recovery Without Surgery

The large majority of MCL injuries, including many complete tears, are treated without an operation.

• Hinged Bracing: a brace allowing bending and straightening while resisting sideways force.
• Early Motion: movement encouraged early rather than immobilizing the knee.
• Grade One Recovery: typically two to four weeks to return to activity.
• Grade Two Recovery: roughly four to eight weeks depending on the athlete and the sport.
• Grade Three Recovery: generally eight to twelve weeks with bracing throughout.

When MCL Surgery Is Needed

• Tibial Sided Complete Tears: where the torn end cannot reach its attachment to heal.
• Combined Ligament Injury: an MCL tear alongside an ACL or PCL reconstruction.
• Persistent Instability: an MCL that has failed to heal after appropriate bracing and time.
• Displaced Tissue: the ligament end trapped in a position where healing is impossible.

Even when an MCL tear accompanies an ACL tear, the MCL is frequently allowed to heal first with bracing, and the ACL is reconstructed afterward once the knee has settled.

Schedule a Knee Evaluation in New York City

Inner knee pain after a blow or a twist usually heals well, and the value of an early evaluation is confirming the grade, checking whether anything else was injured alongside it, and getting the right brace on rather than the wrong one. Dr. Struhl evaluates knee ligament injuries at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.