| Patient group |
Treatment line
| Treatmentshow all |
|
isolated grade I injury
| 1st |
- rest, ice, compression, elevation (RICE) + physiotherapy
-
-
After an MCL injury, the damaged ligament will bleed internally and become inflamed. RICE is started immediately after injury to reduce pain, minimise swelling, and protect the injured tissue, all of which help to speed the healing process. RICE should be employed for 24 to 48 hours.
-
The RICE protocol involves resting the injured leg, icing the injured knee, compressing the knee with an elastic bandage, and elevating the leg above the level of the heart.
-
Initially, the goal of physiotherapy is to decrease pain and restore ROM. Once sufficient progress is made, the focus switches to rebuilding strength and regaining function. Therapy for 2 to 3 weeks is recommended.
-
Exercises are frequently sport- or activity-specific and usually involve hydrotherapy, weight training, and agility training.
-
Only after demonstrating pain-free ROM, 80% to 90% strength, and no swelling/effusion in the lower extremity can the athlete return to sports.
Primary Options
rest
:
rest the injured leg for 24-48 hours
and
ice
:
apply ice or a cold pack for 20 minutes at a time, 4-8 times a day
and
compression
:
compress the knee with an elastic bandage or comparable device
and
elevation
:
elevate the knee above the level of the heart; pillows are often helpful
and
physiotherapy
|
|
|
- protective ambulation
-
-
Protective ambulation may not be needed with an isolated grade I injury; however, if the knee appears unstable or the injury is particularly painful, then it is recommended. A brace that allows full flexion but blocks full extension is recommended for minimising strain on the MCL and protecting against further injury.
-
It is critical that the brace has enough rigidity to stabilise medial and lateral movement. The brace should be worn for 4 to 6 weeks.
-
Crutches may be used for further comfort.
|
|
|
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
-
NSAIDs inhibit cyclo-oxygenase activity and curb prostaglandin synthesis. Their analgesic and anti-inflammatory properties may improve pain and reduce swelling.
-
Caution should be used when prescribing NSAIDs because they may have adverse effects or cause drug interactions in certain groups. They are contraindicated in patients with peptic ulcer disease, recent gastrointestinal bleeding/perforation, or renal disease.
Primary Options
ibuprofen
:
400-800 mg orally every 6-8 hours when required, maximum 2400 mg/day
OR
naproxen
:
500 mg orally every 12 hours when required, maximum 1250 mg/day
|
|
isolated grade II injury
| 1st |
- rest, ice, compression, elevation (RICE) + physiotherapy + protective ambulation
-
-
After an MCL injury, the damaged ligament will bleed internally and become inflamed. RICE is started immediately after injury to reduce pain, minimise swelling, and protect the injured tissue, all of which help to speed the healing process. RICE should be employed for 24 to 48 hours.
-
The RICE protocol involves resting the injured leg, icing the injured knee, compressing the knee with an elastic bandage, and elevating the leg above the level of the heart.
-
Initially, the goal of physiotherapy is to decrease pain and restore ROM. Once sufficient progress is made, the focus switches to rebuilding strength and regaining function.
-
Therapy for 3 to 4 weeks is recommended.
-
Exercises are frequently sport- or activity-specific and usually involve hydrotherapy, weight training, and agility training.
-
Only after demonstrating pain-free ROM, 80% to 90% strength, and no swelling/effusion in the lower extremity can the athlete return to sports.
-
A brace that allows full flexion but blocks full extension is recommended for minimising strain on the MCL and protecting against further injury.
-
It is critical that the brace has enough rigidity to stabilise medial and lateral movement. The brace should be worn for 4 to 6 weeks.
-
Crutches may be used for further comfort.
Primary Options
rest
:
rest the injured leg for 24-48 hours
and
ice
:
apply ice or a cold pack for 20 minutes at a time, 4-8 times a day
and
compression
:
compress the knee with an elastic bandage or comparable device
and
elevation
:
elevate the knee above the level of the heart; pillows are often helpful
and
physiotherapy
and
protective ambulation
|
|
|
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
-
NSAIDs inhibit cyclo-oxygenase activity and curb prostaglandin synthesis. Their analgesic and anti-inflammatory properties may improve pain and reduce swelling.
-
Caution should be used when prescribing NSAIDs because they may have adverse effects or cause drug interactions in certain groups. They are contraindicated in patients with peptic ulcer disease, recent gastrointestinal bleeding/perforation, or renal disease.
Primary Options
ibuprofen
:
400-800 mg orally every 6-8 hours when required, maximum 2400 mg/day
OR
naproxen
:
500 mg orally every 12 hours when required, maximum 1250 mg/day
|
|
isolated grade III injury
| 1st |
- rest, ice, compression, elevation (RICE) + physiotherapy + protective ambulation
-
-
After an MCL injury, the damaged ligament will bleed internally and become inflamed. RICE is started immediately after injury to reduce pain, minimise swelling, and protect the injured tissue, all of which help to speed the healing process. RICE should be employed for 24 to 48 hours.
-
The RICE protocol involves resting the injured leg, icing the injured knee, compressing the knee with an elastic bandage, and elevating the leg above the level of the heart.
-
Initially, the goal of physiotherapy is to decrease pain and restore ROM. Once sufficient progress is made, the focus switches to rebuilding strength and regaining function.
-
Physiotherapy for 8 to 12 weeks is recommended.
-
Exercises are frequently sport- or acitivty-specific and usually involve hydrotherapy, weight training, and agility training.
-
Only after demonstrating pain-free ROM, 80% to 90% strength, and no swelling/effusion in the lower extremity can the athlete return to sports.
-
A brace that allows full flexion but blocks full extension is recommended for minimising strain on the MCL and protecting against further injury. Grade III MCL injuries should be immobilised using a hinged knee brace with the knee at 30° flexion to minimise the distance between the 2 ends of the torn ligament.
-
It is critical that the hinged knee brace has enough rigidity to stabilise medial and lateral movement. Patient can gradually progress to full weight-bearing over 4 weeks. Brace should be worn for 4 to 6 weeks.
-
Crutches may be used for further comfort.
Primary Options
rest
:
rest the injured leg for 24-48 hours
and
ice
:
apply ice or a cold pack for 20 minutes at a time, 4-8 times a day
and
compression
:
compress the knee with an elastic bandage or comparable device
and
elevation
:
elevate the knee above the level of the heart; pillows are often helpful
and
physiotherapy
and
protective ambulation
|
|
|
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
-
NSAIDs inhibit cyclo-oxygenase activity and curb prostaglandin synthesis. Their analgesic and anti-inflammatory properties may improve pain and reduce swelling.
-
Caution should be used when prescribing NSAIDs because they may have adverse effects or cause drug interactions in certain groups. They are contraindicated in patients with peptic ulcer disease, recent gastrointestinal bleeding/perforation, or renal disease.
Primary Options
ibuprofen
:
400-800 mg orally every 6-8 hours when required, maximum 2400 mg/day
OR
naproxen
:
500 mg orally every 12 hours when required, maximum 1250 mg/day
|
| 2nd |
- MCL reconstruction or repair
-
-
Surgical intervention for acute grade III MCL injuries is still controversial. Isolated grade III MCL injuries may warrant operative intervention if there is also a large bony avulsion, tibial plateau fracture, intra-articular entrapment of the end of a ligament, or anteromedial instability (positive anterior drawer test). MCL repair is usually performed 7 to 10 days after injury.
-
In many cases some mild degree of persistent instability remains even after successful reconstruction. Specific complications are unusual, but include decreased ROM (if the MCL graft is placed in a non-anatomical position) and saphenous nerve injury.
|
|
MCL + anterior cruciate ligament (ACL) combined injury
| 1st |
- rest, ice, compression, elevation (RICE) + physiotherapy + protective ambulation
-
-
After an MCL/ACL injury, the damaged ligaments will bleed internally and become inflamed. RICE is started immediately after injury to reduce pain, minimise swelling, and protect the injured tissue, all of which help to speed the healing process. RICE should be employed for 24 to 48 hours.
-
The RICE protocol involves resting the injured leg, icing the injured knee, compressing the knee with an elastic bandage, and elevating the leg above the level of the heart.
-
Prior to surgery, MCL/ACL injury rehabilitation should focus on regaining ROM, rebuilding strength, and resolving knee effusion. This typically takes 4 to 6 weeks.
-
Postoperative rehabilitation generally requires a rigorous physiotherapy regimen.
-
A brace locked in full extension should be used during weight-bearing to minimise strain on the MCL and protect against additional injury.
-
The brace should be opened for ROM exercises. It should be worn for 4 to 6 weeks.
-
Crutches may be used for further comfort.
Primary Options
rest
:
rest the injured leg for 24-48 hours
and
ice
:
apply ice or a cold pack for 20 minutes at a time, 4-8 times a day
and
compression
:
compress the knee with an elastic bandage or comparable device
and
elevation
:
elevate the knee above the level of the heart; pillows are often helpful
and
physiotherapy
and
protective ambulation
|
|
|
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
-
NSAIDs inhibit cyclo-oxygenase activity and curb prostaglandin synthesis. Their analgesic and anti-inflammatory properties may improve pain and reduce swelling.
-
Caution should be used when prescribing NSAIDs because they may have adverse effects or cause drug interactions in certain groups.
-
They are contraindicated in patients with peptic ulcer disease, recent gastrointestinal bleeding/perforation, or renal disease.
Primary Options
ibuprofen
:
400-800 mg orally every 6-8 hours when required, maximum 2400 mg/day
OR
naproxen
:
500 mg orally every 12 hours when required, maximum 1250 mg/day
|
|
|
- ACL reconstruction or repair
-
-
ACL reconstruction is generally recommended after a period of rehabilitation to allow the MCL to heal. Surgery is performed after achieving full ROM and adequate strength, and resolution of knee effusion. At approximately 4 to 6 weeks after injury, the ACL can be reconstructed with a patellar tendon graft or hamstring tendon graft. Autograft or allograft tendon can be used with excellent results.
|
|
|
- MCL reconstruction or repair
-
-
If valgus instability persists after ACL reconstruction, the patient should undergo surgical MCL reconstruction. MCL reconstruction may also be warranted if there is a large bony avulsion, tibial plateau fracture, intra-articular entrapment of the end of a ligament, or anteromedial instability (positive anterior drawer test).
-
In many cases some mild degree of persistent instability remains even after successful reconstruction. Specific complications are unusual, but include decreased ROM (if the MCL graft is placed in a non-anatomical position) and saphenous nerve injury.
|
|
MCL + non-anterior cruciate ligament (ACL) combined injury
| 1st |
- rest, ice, compression, elevation (RICE) + physiotherapy + protective ambulation
-
-
After a multi-ligament injury, the damaged ligaments will bleed internally and become inflamed. RICE is started immediately after injury to reduce pain, minimise swelling, and protect the injured tissue, all of which help to speed the healing process. RICE should be employed for 24 to 48 hours.
-
The RICE protocol involves resting the injured leg, icing the injured knee, compressing the knee with an elastic bandage, and elevating the leg above the level of the heart.
-
Prior to surgery, multi-ligament injury rehabilitation should focus on regaining ROM and resolving knee effusion. This typically takes 2 to 3 weeks. Postoperative rehabilitation generally requires a rigorous physiotherapy regimen.
-
A brace locked in full extension should be used during weight-bearing to minimise strain on the MCL and protect against additional injury. The brace should be opened for ROM exercises. It should be worn for 4 to 6 weeks.
-
Crutches may be used for further comfort.
Primary Options
rest
:
rest the injured leg for 24-48 hours
and
ice
:
apply ice or a cold pack for 20 minutes at a time, 4-8 times a day
and
compression
:
compress the knee with an elastic bandage or comparable device
and
elevation
:
elevate the knee above the level of the heart; pillows are often helpful
and
physiotherapy
and
protective ambulation
|
|
|
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
-
NSAIDs inhibit cyclo-oxygenase activity and curb prostaglandin synthesis. Their analgesic and anti-inflammatory properties may improve pain and reduce swelling.
-
Caution should be used when prescribing NSAIDs because they may have adverse effects or cause drug interactions in certain groups.
-
They are contraindicated in patients with peptic ulcer disease, recent gastrointestinal bleeding/perforation, or renal disease.
Primary Options
ibuprofen
:
400-800 mg orally every 6-8 hours when required, maximum 2400 mg/day
OR
naproxen
:
500 mg orally every 12 hours when required, maximum 1250 mg/day
|
|
|
- surgical repair of MCL + non-ACL ligament
-
-
MCL reconstruction is usually warranted because its healing capacity may be compromised in multi-ligament injuries. Surgery is especially warranted if there is a large bony avulsion, tibial plateau fracture, intra-articular entrapment of the end of a ligament, or anteromedial instability (positive anterior drawer test).
-
MCL repair is usually performed 7 to 10 days after injury.
-
In many cases some mild degree of persistent instability remains even after successful reconstruction. Specific complications are unusual, but include decreased ROM (if the MCL graft is placed in a non-anatomical position) and saphenous nerve injury.
-
Surgical reconstruction or repair of the other injured ligament (posterior cruciate ligament, meniscus, lateral collateral ligament) is usually warranted shortly (<3 weeks) after injury. Compared with non-surgical management or a delay in surgery, early operative treatment of the multi-ligament-injured knee yields improved functional and clinical outcomes. Reconstruction of the posterolateral corner is preferred over repair as it results in decreased revision rates.
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