Management of MCL Tears and TKR Prosthesis Selection

Non-Surgical Treatment of MCL Tears

Most isolated MCL injuries, including complete grade III tears, should be managed non-surgically with early functional rehabilitation, as this approach results in good patient outcomes in the majority of cases 1
Non-surgical treatment of the MCL results in good outcomes even when the ACL is surgically reconstructed 2, 1
The American Academy of Orthopaedic Surgeons suggests that even when combined with ACL tears requiring reconstruction, the MCL component should be treated conservatively while the ACL is surgically reconstructed 2

Surgical treatment of the MCL may be considered only in select cases with severe instability 2

Total knee replacement is safe and effective for end-stage knee osteoarthritis, with good or excellent outcomes for pain and function reported in 89% of patients up to five years after surgery, according to the Annals of the Rheumatic Diseases 3
Standard unconstrained or posterior-stabilized TKR prostheses are appropriate when the MCL is intact and functional, as recommended by the Annals of the Rheumatic Diseases 3
When significant MCL laxity or deficiency exists in the setting of advanced osteoarthritis requiring TKR, more constrained implants are necessary to compensate for ligamentous insufficiency, as suggested by the Annals of the Rheumatic Diseases 3
The degree of constraint should match the severity of ligamentous instability present at the time of arthroplasty, according to the Annals of the Rheumatic Diseases 3

The American Academy of Family Physicians recommends against using prophylactic knee braces to prevent MCL injuries, as evidence shows they are ineffective and may increase medial knee forces 4