Medial Collateral Ligament (MCL) Sprain

Position	Average % Difference PPG Change From Pre-Injury Compared to 1st Game After Injury	Average % Difference PPG Change From Pre-Injury Compared to Games 2-3 After Injury	Average % Difference PPG Change From Pre-Injury Compared to Games 4-6 After Injury
QB	-25	-11.9	-12.9
RB	-14.2	-21	-11
WR	-58.1	-5.6	+24
TE	-43.1	-18.7	-33.9

Position	Average Change in Snap% From Pre-Injury Compared to 1st Game After Injury	Average Change in Snap% From Pre-Injury Compared to Games 2-3 After Injury	Average Change in Snap% From Pre-Injury Compared to Games 4-6 After Injury
QB	+1.8	+1.8	-4.8
RB	-21	-16	-13.2
WR	-28.5	-28.6	-10
TE	-27.1	-23.8	-25.5

Anatomy/Cause of MCL Injury

The MCL provides stability to the knee’s medial (inside) portion. It runs from the femur to the tibia and helps prevent a dynamic knee valgus moment (inward collapse).¹ This can be seen below. In football, this ligament will typically be injured when making a cut or if tackled from the outside with the athlete’s foot planted. The MCL is the most commonly injured ligament in the knee, accounting for 7.9% of all knee injuries.²

Luckily, the MCL has a good blood supply and thus has high healing potential. Most MCL sprains will heal without the need for surgical procedures. After this type of injury, the athlete can expect swelling, decreased range of motion, and pain with weight bearing. Depending on the severity of the sprain, the athlete may be placed on crutches for a few days-weeks while swelling subsides and range of motion is restored. 

Rehab Process For MCL Injuries

As with most injuries, the injury’s severity will indicate the required treatments. Often after an MCL injury, the athlete may have swelling in the knee and decreased range of motion. They may also have pain with walking and higher-level activities like running and changing direction. Initial rehab focuses on eliminating swelling and restoring range of motion. Mild sprains may only require a few days to return to normal, while moderate-severe sprains may take up to 6+ weeks to return to play. In a study of high school football players, the average return to play after grade 1 sprains was 10.6 days, while grade 2 sprains were 19.5 days.³

In a study of European soccer players, the median time to return to play after an MCL sprain was 33 days.⁴ Of these athletes, 86% of the injuries are considered “moderate-severe,” and 14% required surgical intervention. The remaining athletes were able to rehab their knees non-operatively. In this study, 71% of the athletes were able to return to play at their prior level. Although we cannot extract this data and apply it directly to NFL players, it certainly gives insight into the expected outcomes after MCL injury in elite athletes who are placed under similar demands to that of an NFL player.

Initial rehab should focus on reducing knee swelling while gradually restoring range of motion. These players may wear a hinged knee brace during this time, but immobilization is not recommended as it may result in a weaker ligament.² While range of motion is being restored, the athlete should also focus on improving quadriceps, hamstring, and hip strengthening. Depending on injury severity, some individuals can progress through strengthening exercises faster than others. Hip abduction strengthening is imperative to help prevent future injuries in these athletes. With stronger hips, the athlete should be able to control and prevent the dynamic knee valgus motion, which is viewed as the typical mechanism of injury for these athletes.

Sources

1. Liu F, Yue B, Gadikota HR, et al. Morphology of the medial collateral ligament of the knee. J Orthop Surg Res. 2010;5:69. Published 2010 Sep 16. doi:10.1186/1749-799X-5-69
2. Andrews K, Lu A, Mckean L, Ebraheim N. Review: Medial collateral ligament injuries. J Orthop. 2017;14(4):550-554. Published 2017 Aug 15. doi:10.1016/j.jor.2017.07.017
3. Derscheid GL, Garrick JG. Medial collateral ligament injuries in football: nonoperative management of grade I and grade II sprains. Am J Sports Med.1981;9:365–368.
4. Lavoie-Gagne OZ, Retzky J, Diaz CC, et al. Return-to-Play Times and Player Performance After Medial Collateral Ligament Injury in Elite-Level European Soccer Players. Orthop J Sports Med. 2021;9(9):23259671211033904. Published 2021 Sep 28. doi:10.1177/23259671211033904