MCL Injuries: Does Prophylactic Bracing Help?

discussion today with an article authored by our guest, Dr. Brett Owens, titled “The Epidemiology of Medial Collateral Ligament Sprains in Young Athletes” from the 2014 issue of AJSM.

The authors performed a longitudinal cohort study of US military cadets and found that MCL injuries are relatively common in the athletic population. Male athletes are at significantly greater risk than females –of the 128 injuries in this study, 89% occurred in males. Intercollegiate athletes are also at greater risk than athletes participating in intramural sports. The incidence of MCL injury was highest in wrestling and hockey. In terms of time missed, the average amount of time was 23 days but this differed based on the grade of injury – with grade I sprains only missing a median of 13.5 days.

Up next is a Current Concepts Review article from JBJS authored by Robert LaPrade and colleagues at the University of Minnesota. Some takeaways from this paper: First, the medial structures of the knee (including the superficial and deep MCL as well as the posterior oblique ligament) are the most commonly injured ligamentous structures of the knee. The majority of medial knee ligament tears are isolated injuries. Physical examination is the initial method of choice for diagnosis and includes application of a valgus load to the knee in both full extension as well as in 20 to 30 degrees of knee flexion. In terms of imaging, valgus stress radiographs and MRI are useful to confirm and grade the injury.

We wrap up Part I with a discussion on the prevention of MCL injury and review an article from the August issue of OJSM this year titled “Prophylactic Knee Bracing in Offensive Lineman of the NFL – A Retrospective Analysis of Usage Trends, Player Performance and Major Knee Injury.” 

Dr. Robert Gallo and team at Penn State found that brace wears had a significantly lower rate of major knee injury, defined as an injury requiring time missed. The most common knee injury in nonbracers was an isolated MCL injury. There was no difference in player performance between bracers and nonbracers. Interestingly, despite this data, brace usage has steadily declined – from 16.3% in 2014 to 5.6% in 2020 – specifically at the rookie level.

We are joined today by Dr. Brett Owens, a board-certified orthopedic surgeon at University Orthopaedics in Providence Rhode Island, who specializes in complex shoulder, knee and sports medicine. He is the Chief of Sports Medicine at the Miriam Hospital in Providence, RI and the Director of the Rhode Island Cartilage Repair Center. 

Author

The Sports Docs The Sports Docs – Dr. Logan & Dr. Bassett – are friends & former co-residents from the Harvard Combined Orthopaedic Residency Program, who went onto esteemed sports medicine fellowships at The Steadman Clinic and The Rothman Institute, respectively. Dr. Logan practices in Denver, CO, and serves as Head League Physician of the Premier Lacrosse League & as a team physician for U.S. Ski & Snowboard. Dr. Bassett is the director of the Women’s Sports Medicine Center at the Orthopedic Institute of New Jersey and practices across northern NJ, primarily in Morris and Sussex Counties.