MCL, LCL & PCL Injuries: A Physical Therapist’s Masterclass

MCL, LCL and PCL injuries each need a different clinical decision, and to go along with today’s 3-part masterclass I have not one but three infographics to share…

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In today’s video Kevin Coughlin and I bring together three full lessons on MCL, LCL and PCL injuries, from injury mechanism to return to sport:

MCL, LCL and PCL injuries require different clinical decisions. This knee ligament injury masterclass brings together three detailed lessons for physical therapists, PTAs, athletic trainers and clinicians helping active patients return to training and sport.

We review injury mechanisms, anatomy, ligament grading, history and examination, special tests, imaging and differential diagnosis. Then we work through nonoperative rehabilitation, surgical indications, repair vs reconstruction, postoperative rehab and return-to-sport outcomes. We also cover posteromedial and posterolateral corner injuries and combined ligament injuries. Use the timestamps below to jump to the ligament or clinical question relevant to your next patient.

What You’ll Learn About MCL, LCL & PCL Injuries

• How MCL, LCL and PCL injuries happen and how to grade them
• The anatomy of the posteromedial and posterolateral corners, and why they change your plan
• History, special tests and imaging for each ligament (and when an X-ray or MRI actually helps)
• Differential diagnosis, including the injuries that masquerade as a collateral sprain
• Nonoperative rehab and return-to-sport timelines for each ligament
• Who needs surgery, repair vs reconstruction, and postoperative rehab guidelines
• How to manage combined injuries: MCL + ACL, multiligament knee injuries and PLC injuries

MCL, LCL & PCL Injuries: Key Points From the Research

• Most PLC and PCL injuries aren’t isolated. In 331 acute knee injuries with a hemarthrosis, 87% of posterolateral corner injuries and 52% of PCL tears came with other ligament injuries (LaPrade 2007). Find one ligament injury? Keep looking.
• Most MCL injuries do well without surgery. Grade I and II MCL injuries tolerate immediate weight bearing and progressive strengthening, while brace use is inconsistently reported in the research (Svantesson 2024). Grade 1 sprains average about 10 days missed and grade 2 about 35 days.
• Combined ACL + MCL injury? Nonoperative management, repair or reconstruction of the MCL produced comparable results in a 2024 meta-analysis (Shultz 2024), so most MCLs are allowed to heal before the ACL is addressed.
• When the medial side needs surgery, athletes still get back. After MCL and posterior oblique ligament reconstruction, 88–91% returned to recreational sport within 6–12 months (D’Ambrosi 2021).
• Isolated grade 3 LCL tears can be treated without surgery. In NFL players, nonoperative care meant an average of 2.0 weeks missed vs 14.5 weeks after surgical repair, and all 9 players returned to play the following season (Bushnell 2010).
• The PCL can heal. 12 of 18 PCL tears regained continuity on MRI at 1 year. Tears with less than 8 mm of posterior subluxation healed, while those over 12 mm with combined PLC injuries did not (Mariani 2005).
• Athletes return after nonoperative PCL rehab. In 46 athletes with grade II–III PCL injuries, mean return to full competitive sport was 16.4 weeks and 91.3% were playing at the same or higher level at 2 years (Agolley 2017).
• But PCL deficiency has long-term costs. In 4,169 patients, PCL tears were linked to more meniscus tears, osteoarthritis and knee replacement. Reconstruction within 1 year lowered that risk (Wang 2018).
• PCL reconstruction isn’t a guaranteed fix. 45% of isolated PCL reconstructions met the definition of clinical failure at 2 years, and traffic-related injuries carried more than 6-fold higher odds of failure (Zsidai 2025).

Our goal? Help you diagnose and rehab MCL, LCL and PCL injuries with confidence, so your athletes get back to the sport and training they love.

Video Timestamps

• 0:00 Introduction
• 0:28 MCL injury masterclass
• 1:26 MCL injury prevalence and mechanisms
• 5:23 MCL injury grading
• 7:48 MCL anatomy and healing
• 10:52 Posteromedial corner and biomechanics
• 19:07 MCL history, examination and special tests
• 24:33 MCL imaging
• 27:03 FPF Insiders Academy
• 29:28 MCL differential diagnosis
• 31:38 MCL: conservative care vs surgery
• 32:49 Nonoperative MCL rehabilitation
• 36:58 MCL return to sport without surgery
• 38:21 Who needs MCL surgery?
• 41:16 Combined MCL and ACL injuries
• 43:26 MCL repair vs reconstruction
• 46:33 Postoperative MCL rehabilitation
• 49:26 MCL return to sport after surgery
• 53:35 LCL injury masterclass
• 54:11 LCL and posterolateral corner injuries
• 1:00:44 LCL injury mechanisms and grading
• 1:04:22 LCL and PLC anatomy
• 1:08:17 LCL biomechanics and dynamic stability
• 1:13:52 LCL history and examination
• 1:17:43 LCL objective examination and special tests
• 1:18:31 Free FPF mini course
• 1:27:43 LCL imaging
• 1:30:10 LCL differential diagnosis
• 1:31:50 LCL: conservative care vs surgery
• 1:35:45 Grade 3 LCL injuries in NFL athletes
• 1:40:56 Nonoperative LCL rehabilitation
• 1:44:09 Isolated LCL return-to-sport timelines
• 1:46:11 Who needs LCL surgery?
• 1:47:08 LCL repair vs reconstruction
• 1:49:55 Multiligament knee injuries
• 1:51:43 Postoperative LCL rehabilitation
• 1:54:56 LCL return-to-sport outcomes
• 2:04:22 PCL injury masterclass
• 2:04:47 PCL injury prevalence and anatomy
• 2:06:46 Can the PCL heal?
• 2:10:34 PCL bracing and injury grading
• 2:14:03 PCL biomechanics and dynamic stability
• 2:16:42 PCL injury mechanisms
• 2:22:49 PCL history, examination and special tests
• 2:25:51 PCL imaging
• 2:33:13 PCL differential diagnosis
• 2:35:55 PCL: conservative care vs surgery
• 2:43:04 Osteoarthritis and meniscus injury risk
• 2:45:04 PCL return-to-sport outcomes
• 2:46:47 Nonoperative PCL rehabilitation
• 2:56:22 Who needs PCL surgery?
• 2:58:25 PCL surgical options and outcomes
• 3:04:39 Return to sport after PCL reconstruction
• 3:10:50 Postoperative PCL rehabilitation
• 3:13:46 Watch next: ACL injuries

Happy rehabbing,

– Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

• FPF Mini Course – 7 Reasons Why Injuries Happen in the Gym and What to do About it
• Watch Next: What Physical Therapists NEED to Know About ACL Injuries (YouTube)
• What Physical Therapists NEED to Know About MCL Injuries
• What Physical Therapists NEED to Know About LCL Injuries
• What Physical Therapists NEED to Know About PCL Injuries
• How to Diagnose LCL Injuries Like a PRO!
• The Complete Guide to ACL Injuries & Rehabilitation
• Meniscus Tear Rehab MASTERCLASS | Diagnosis, Surgery, PT & Return to Sport
• Are Knee Extensions BAD After ACL Reconstruction? What the Research Actually Says
• Get BACK to 100% Knee Mobility After Surgery!
• Your Complete Guide to PT Manual Therapy for The Knee

Looking for other ways to support me that are 100% free?

• Like, comment and share on youtube, facebook and instagram
• Leave a 5-star review on apple podcasts

Thank you!

Dan Pope DPT, OCS, CSCS

References:

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