MCL Injury (Medial Collateral Ligament Tear) and MCL Surgery in Bath & Bristol

An MCL injury is damage to the medial collateral ligament, the main ligament on the inner side of the knee. The MCL helps stabilise the knee against forces that push it inward and also contributes to rotational stability. MCL injuries are common in sport and can range from a mild sprain to a complete tear.

Image of an MCL sprain showing the medial collateral ligament on the inner knee, a common cause of pain and instability after injury — Diagram illustrating an MCL sprain - showing the medial collateral ligament on the inner side of the knee.

Mr Simon Abram, Consultant Specialist Knee Surgeon, provides specialist assessment and treatment planning for MCL injuries in Bath and Bristol. Many MCL injuries heal well with non-surgical treatment, but in selected cases MCL repair or MCL reconstruction is considered to restore stability and protect the knee long-term.

What does the MCL do?

The MCL runs along the inner side of the knee, from the thigh bone (femur) to the shin bone (tibia). It helps:

Prevent the knee from opening up on the inner side (valgus stress)
Support stability during twisting and pivoting movements
Work alongside other ligaments (including the ACL) to maintain overall knee stability

How MCL injuries happen

MCL injuries typically occur when a force pushes the knee inward, for example:

A tackle or collision to the outside of the knee
An awkward landing or twist with the knee collapsing inward
Skiing or contact sport injuries
Combined ligament injuries (for example ACL + MCL)

Symptoms of an MCL injury

Pain and tenderness along the inner side of the knee
Swelling (often localised, sometimes more widespread)
Feeling the knee is unstable, especially side-to-side
Pain when turning, pivoting or changing direction
Reduced confidence with walking on uneven ground

When to seek urgent assessment

Seek urgent advice if you cannot weight-bear, have a locked knee, major swelling after injury, numbness/weakness in the leg, or if you suspect a multi-ligament injury.

Grading: how severe is the tear?

MCL injuries are commonly described in grades:

Grade 1: mild sprain, ligament stretched but intact
Grade 2: partial tear, more pain and some looseness
Grade 3: complete tear, significant looseness/instability

The grade helps guide treatment, but decision-making also depends on associated injuries, your stability symptoms, and your goals.

Assessment and diagnosis (Bath & Bristol)

Accurate diagnosis matters because an MCL injury can occur alone or alongside other injuries (especially ACL, meniscus, or the posteromedial corner). Mr Simon Abram offers specialist assessment for MCL injuries in Bristol and Bath.

Assessment usually includes:

History: mechanism of injury, swelling pattern, instability symptoms, sport/work demands
Examination: tenderness location, range of motion, valgus stress testing, and assessment of other ligaments
X-rays: to rule out fracture or avulsion injury where appropriate
MRI scan: often used to confirm tear grade, location (femoral vs tibial side), and associated injuries

Non-surgical treatment (common and often effective)

Many isolated MCL injuries heal well without surgery because the MCL has a relatively good blood supply compared with some other ligaments.

Non-operative treatment may include:

Short-term activity modification to allow healing
A brace in selected cases to protect against inward stress while walking
Physiotherapy to restore movement, reduce swelling, and rebuild strength
Progressive return to sport based on function and stability, not just time

Even for higher-grade tears, a structured non-surgical approach is often used initially–especially when the MCL is expected to heal and stability is improving.

When is surgery considered?

Surgery is considered when the ligament is unlikely to heal in a stable way, or when persistent instability would compromise function or other reconstructions (such as an ACL reconstruction).

MCL repair: typical indications

MCL repair means re-attaching or repairing the injured ligament tissue. It is most often considered when:

There is a clear avulsion-type injury (ligament pulled off bone) that is suitable for reattachment
The injury is acute and tissue quality is good
There is persistent medial laxity despite early management and the tear pattern supports repair, especially in combination with ACL reconstruction
The MCL injury is part of a multiligament injury requiring early stabilisation

MCL reconstruction: typical indications

MCL reconstruction uses a graft to rebuild the ligament. It may be considered when:

There is chronic medial instability (ongoing looseness months after injury)
The MCL has healed in a lengthened position and the knee remains unstable
There is combined instability (for example ACL + MCL) where persistent medial laxity would increase stress on an ACL graft
There is poor tissue quality or a tear pattern not suitable for repair
Previous repair/reconstruction has failed and stability remains limiting

In practice, the choice between repair and reconstruction depends on the timing (acute vs chronic), tear location, tissue quality, and the presence of other ligament injuries.

MCL reconstruction graft options

If reconstruction is recommended, the ligament is rebuilt using graft tissue. Options can include autograft (your own tissue), allograft (donor tissue), or synthetic augmentation in selected cases. The best choice depends on your injury pattern, goals, previous surgery, and surgeon preference.

Autograft (your own tissue)

Autograft options commonly use tendon tissue from your leg. Depending on your knee and previous procedures, options may include:

Hamstring tendon graft options
Other suitable local tendon grafts where appropriate

Autografts avoid donor tissue and can provide robust reconstruction, but they involve taking tissue from another area that can make rehabilitation more challenging.

Allograft (donor tissue)

Allograft uses sterilised donor tendon (transplant). This can be useful when:

Multiple ligaments need reconstruction (multiligament injuries)
Previous graft harvest limits autograft options
A reconstruction without donor-site symptoms (e.g. from hamstrings) is preferred

Synthetic options (selected cases)

Synthetic materials may be used as augmentation (to protect a repair) or as part of a reconstruction strategy in selected cases. This is not appropriate for every patient but has advantages as a robust option with the need for a soft-tissue graft. It comes with some additional risks of causing local irritation or stiffness. Your consultation will include a clear discussion of which graft options are suitable and why one approach is recommended for your knee.

What happens during MCL surgery?

The surgical plan depends on whether repair or reconstruction is needed and whether the MCL injury is isolated or combined with other ligament injuries.

Repair may involve reattaching the ligament to bone using anchors or sutures and tightening stretched structures where appropriate.
Reconstruction involves placing a graft in positions that restore the MCL’s stabilising function, often with fixation to the femur and tibia.

In combined injuries, MCL treatment is planned alongside ACL/PCL/other ligament procedures to restore balanced stability.

Recovery and rehabilitation

Rehabilitation is essential after MCL injury, whether treated non-surgically or surgically.

Non-surgical recovery

Focus on reducing swelling, restoring movement, and rebuilding strength
Bracing may be used for higher-grade tears or if instability symptoms are significant
Return to sport is criteria-based, guided by strength and stability

After MCL repair or reconstruction

A brace is commonly used initially to protect the healing ligament
Weight-bearing and range of motion progression are guided by the procedure and stability goals
Strengthening and movement retraining progress in stages
Return to pivoting sport is planned cautiously and based on testing and function

Because medial stability influences overall knee mechanics, rehabilitation aims to restore confident side-to-side control and rotational stability.

Risks and considerations

All surgery carries risks. For MCL repair/reconstruction, potential issues include:

Infection, blood clots, wound healing problems
Stiffness or prolonged swelling
Persistent medial laxity or recurrent instability
Over-tightening (rare), which can feel restrictive if the knee is made too tight
Ongoing pain or difficulty returning to high-demand sport

These risks are discussed in detail in a personalised consultation, alongside expected outcomes and alternatives.

Frequently asked questions

Will my MCL tear heal without surgery?

Many isolated MCL injuries heal well with bracing and physiotherapy. Surgery is considered when healing is unlikely to restore stable function or when instability persists. It is very important to be seen and assessed early by a specialist surgeon to determine if surgery may be necessary, as this is best done early to avoid more complex surgery or complications at a later stage.

How do you decide between repair and reconstruction?

Repair is more often considered in acute, repairable tears (especially avulsions with good tissue). Reconstruction is more often used in chronic instability, poor tissue quality, or when the ligament has healed in a lengthened position.

Do I need surgery if I also have an ACL injury?

Not always. Some MCL injuries heal sufficiently while the ACL is treated with rehabilitation or reconstruction. However, persistent medial laxity can increase stress on an ACL graft, so combined treatment is considered when instability patterns suggest it is necessary.

Can I be assessed for an MCL injury in Bath or Bristol?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for MCL injuries in Bath and Bristol, including rehabilitation-led care, repair where appropriate, and reconstruction options for chronic or complex instability.