The large majority of medial collateral ligament (MCL) injuries can be managed without surgery, however, a subset of individuals with MCL complex injuries benefit from an an atomic repair or reconstruction. Successful return to play necessitates on strict adherence to the post-operative rehabilitation protocol and a focused return to play protocol.
Surgeons assess the recovery of strength compared to the contralateral lower extremity, as well as clinical and objective knee stability. Formal testing may be performed with sport-specific functional tests, such as the Vail Sport Test™; however, no single test exists to meet the functional and sport needs of each athlete, requiring an individualized approach by the surgeon and the rehab professional.
Multiple factors must be considered. An athlete’s preferred sport may be affected by geography; for example, flat land versus mountain-based activity, and the demands these activities place on the recovered extremity must be considered.
Further, functional testing provides an inaccurate marker for risk of injury because the analysis is performed under non-fatigued conditions. Fatigue protocols may be introduced to return to sport testing, however, we must also acknowledge these additions never mimic a real-world, game day setting perfectly.
At the most basic level, return to sport is appropriate when the athlete can demonstrate appropriate strength on functional testing and proper alignment and control with agility and dynamic movements, as well as objective knee stability on clinical examination.