Knee – Medial Co-lateral Ligament (MCL) Tears

What is an MCL?

The MCL is the main ligament supporting the inside of the knee. It is a long wide ligament starting from above the knee and continuing to 10cm below the knee joint line. It is what is known as an ‘extra-capular’ ligament, menaing that it is outside the joint capsule and therefore receives blood supply and has the ability to heal.

Do they require surgery?

MCL tears are graded as either I (partial tear with no laxity) II (partial tear with some laxity/weakness) or III (full tear). As the MCL is in fact a thickening of the joint capsule, even full tears have the ability to heal well without surgery. The only time that surgery is appropriate to reattach the ligament is if other structures in the knee have also been torn and the knee is very unstable.

Do they require bracing?

The more substantial Grade II and III MCL tears require some time in a brace that restricts the range of motion from 40-90 degrees to give the ligament optimum conditions to heal. When the knee is bent deeply or straightened fully the ends of the tear become separated, so we aim to keep them closer together. The benefits of bracing to the healing ligament must be balanced with the risk of the knee becoming stiff, so older athletes tend to have shorter bracing time.

How long do they take to heal?

Grade I usually heal in 2-3 weeks. Grade II and III take from 4-12 weeks for full recovery depending on various factors.

Do they require rehabilitation?

MCL ruptures can leave the knee stiff and weak, so a structured rehabilitation program by a physiotherapist is required to achieve full function.