Medial Collateral Ligament (MCL) Repair or Reconstruction

Physical Therapy Protocol

Phase I – Protection and Early Motion (Weeks 0–6)

Goals:

• Protect surgical repair
• Reduce pain and inflammation
• Prevent quadriceps inhibition and atrophy
• Initiate controlled range of motion
• Maintain NWB status and brace precautions

Brace:

• Locked in full extension (0–0°) while upright at all times
• Removed only for ROM exercises in a supine position

Weight Bearing:

• Non-weight bearing (NWB) with crutches for full 6 weeks

Range of Motion (ROM):

• Supine or Figure 4 position to avoid varus stress
• Weeks 0–2: 0–90° ROM only
• Weeks 3–6: Progress to full ROM as tolerated
• No active or resisted knee flexion

Therapeutic Exercises:

• Ankle pumps
• Quadriceps sets
• Hamstring sets
• Straight leg raises (brace on)
• Patellar mobilization
• Supine heel slides (within ROM limits)
• Core and hip strengthening (without adduction/abduction)

Modalities:

• Cryotherapy
• E-stim for quadriceps re-education as needed

Phase II – Progressive Strengthening & Gait Training (Weeks 7–12)

Goals:

• Normalize gait pattern
• Restore full ROM
• Begin functional strengthening
• Initiate weight-bearing progression

Brace:

• Discontinued once quadriceps control is adequate (typically Week 6–7)

Weight Bearing:

• Begin partial weight bearing Week 7, progressing to WBAT over 2–3 weeks
• Wean off crutches as gait normalizes

Range of Motion:

• Full ROM encouraged
• Continue stretching to maintain full extension and flexion

Therapeutic Exercises:

• Closed chain quad and hamstring strengthening
• Step-ups and mini-squats
• Leg press (0–60° initially)
• Stationary bike and elliptical (low resistance)
• Balance training and proprioception drills
• Begin pool walking/running if incisions healed

Phase III – Advanced Strengthening and Neuromuscular Control (Weeks 13–20)

Goals:

• Improve strength, balance, and control
• Prepare for dynamic and sport-specific movements
• Achieve muscular symmetry

Therapeutic Exercises:

• Single-leg balance drills
• Agility ladder drills
• Lateral movements and cutting drills
• Sport cord resisted movement
• Hamstring curls, bridges, lunges
• Running progression (start linear → then directional changes)
• Begin low-level plyometrics

Phase IV – Return to Sport Phase (Weeks 20+)

Goals:

• Return to unrestricted sports participation
• Full functional symmetry
• Confidence and strength in dynamic environments

Therapeutic Exercises:

• High-level plyometrics (bounding, hops, box jumps)
• Acceleration/deceleration drills
• Change-of-direction and reactive agility work
• Sport-specific training tailored to position/activity

Criteria for Return to Sport:

• Full, pain-free ROM
• Strength ≥ 90% of contralateral limb
• Successful completion of functional sport tests
• Surgeon clearance