Nonoperative management of complete tears of the medial collateral ligament

Ten years of experience in treating complete tears of the medial collateral ligament (MCL) nonoperatively are reported, with an emphasis on the role of arthroscopy in the diagnosis of patients with suspected complete MCL tears. Physical examination and assessment of findings are followed by a three-phase treatment protocol. The first phase consists of an orthosis and 30 degrees of flexion, partial weight-bearing with crutches, and strengthening exercises; the second phase allows knee motion from 30 degrees to 90 degrees, followed by the addition of isotonic and isokinetic exercises, and full weight-bearing without crutches, if tolerable; the third phase includes removal of the orthosis, continuation of the exercise regimen, and institution of a running program. Successful treatment depends on clinical or arthroscopic confirmation of a normal anterior cruciate ligament.