Collateral Ligament Pathology Workup

  • Author: Michael P Nogalski, MD; Chief Editor: Carlos J Lavernia, MD, FAAOS   more...
 
Updated: Feb 6, 2012
 

Imaging Studies

  • Collateral ligament injuries
    • Radiography and a physical examination usually suffice for grade 1 injuries, in which the diagnosis appears straightforward. With more pain, larger effusions, or if the diagnosis is unclear, MRI may be of value. Examination findings may be more accurate with a repeat evaluation 2 weeks after the injury.
    • MRI is very sensitive and specific for MCL injuries; however, only a physical examination can quantitate or grade the injury. Meniscal, other ligamentous, patellofemoral, and possibly chondral injuries can be identified. In addition to a careful and thorough physical examination, grade 3 MCL injuries may be associated with other concomitant injuries, and if suspicion exists, MRI is helpful in evaluation.
  • Lateral collateral ligament injuries
    • Plain radiographic findings may be normal or, in bony avulsions of the LCL, show a fibular head avulsion fracture.
    • MRI is the optimal test to demonstrate the lateral structures. MRI can also be used to evaluate the other structures in the knee, such as the PCL, ACL, MCL, and menisci.[22]
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Other Tests

  • Lateral collateral ligament injuries
    • Posterolateral drawer test: With the knee in 30 and 90 degrees of flexion and the foot supported by the examiner, a posterolateral spin is placed on the tibia by pushing laterally on the medial anterior tibia. Findings should ideally be compared with a normal opposite knee. The angle of the foot with respect to the midsagittal plane can be used to gauge the amount of spin that the tibia has with respect to each femur. If the posterolateral spin of the tibia is greatest at 30 degrees and minimal at 90 degrees, then a posterolateral complex injury is likely. If the posterolateral spin is larger at 90 degrees, then PCL injury associated with a lateral complex injury is likely.
    • External recurvatum test: Both legs are raised off the examination table with the examiner grasping the great toe while the patient is supine. If the tibial tubercle rotates outward and the knee goes into recurvatum, laxity of the posterolateral corner is present. Comparison with the opposite lower extremity can help identify normal versus abnormal rotation and recurvatum.
  • Posterolateral spin test at 30 and 90 degrees: This test uses the same principle as the posterolateral spin test above but uses the thigh-foot angle as measured with an external rotation on the tibia exerted on the feet with the knees at 30 and 90 degrees. Having an assistant hold the knees together and performing this test with the patient supine is helpful. The patient is asked to place his or her knees at positions of 30 and 90 degrees as set by the examiner. With an assistant holding the knees together, the thigh-foot angle is assessed after exerting an external rotation force on both feet simultaneously. Side-to-side differences of greater than 10 degrees are thought to be significant. Significantly increased external rotation at 30 degrees indicates a posterolateral complex injury. If the spin is also increased at 90 degrees, then likely both the PCL and posterolateral complex are injured.
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Diagnostic Procedures

  • Examination under anesthesia has some value, especially in combined ligament injuries when evaluation of the knee would be painful and less accurate. Arthroscopy has little value in the evaluation of these specific injuries but does aid in the evaluation of associated ligamentous, chondral, and meniscal injuries.
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Contributor Information and Disclosures
Author

Michael P Nogalski, MD  Consulting Surgeon, Department of Orthopedics, St Joseph Hospital of Kirkwood

Michael P Nogalski, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert D Bronstein, MD  Associate Professor, Department of Orthopedics, Division of Athletic Medicine, University of Rochester School of Medicine

Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS  Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital

Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society

Disclosure: Zimmer Stock Implant Designer

References

  1. Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc. Jun 2006;14(2):84-90. [Medline].

  2. Wilson WT, Deakin AH, Payne AP, Picard F, Wearing SC. Comparative Analysis of the Structural Properties of the Collateral Ligaments of the Human Knee. J Orthop Sports Phys Ther. Oct 25 2011;[Medline].

  3. Liu F, Gadikota HR, Kozánek M, Hosseini A, Yue B, Gill TJ, et al. In vivo length patterns of the medial collateral ligament during the stance phase of gait. Knee Surg Sports Traumatol Arthrosc. May 2011;19(5):719-27. [Medline]. [Full Text].

  4. Kitayama S, Onodera S, Kondo E, Kobayashi T, Miyatake S, Kitamura N, et al. Deficiency of macrophage migration inhibitory factor gene delays healing of the medial collateral ligament: a biomechanical and biological study. J Biomech. Feb 3 2011;44(3):494-500. [Medline].

  5. Liu F, Yue B, Gadikota HR, Kozanek M, Liu W, Gill TJ, et al. Morphology of the medial collateral ligament of the knee. J Orthop Surg Res. Sep 16 2010;5:69. [Medline]. [Full Text].

  6. Grana WA, Janssen T. Lateral ligament injury of the knee. Orthopedics. Jul 1987;10(7):1039-44. [Medline].

  7. Baker CL, Liu SH. Collateral ligament injuries of the knee: operative and non-operative approaches. In: Fu FH, et al, eds. Knee Surgery. Baltimore, Md:. Lippincott Williams & Wilkins;1994.

  8. Griffin LY. Orthopedic Knowledge Update-Sports Medicine. Rosemont, Ill:. American Academy of Orthopedic Surgeons;1994.

  9. McDougall JJ, Yeung G, Leonard CA, et al. Adaptation of post-traumatic angiogenesis in the rabbit knee by apposition of torn ligament ends. J Orthop Res. Jul 2000;18(4):663-70. [Medline].

  10. Lyon RM, Akeson WH, Amiel D, et al. Ultrastructural differences between the cells of the medical collateral and the anterior cruciate ligaments. Clin Orthop. Nov 1991;(272):279-86. [Medline].

  11. Woo SL, Chan SS, Yamaji T. Biomechanics of knee ligament healing, repair and reconstruction. J Biomech. May 1997;30(5):431-9. [Medline].

  12. Indelicato PA. Non-operative treatment of complete tears of the medial collateral ligament of the knee. J Bone Joint Surg Am. Mar 1983;65(3):323-9. [Medline].

  13. Inoue M, McGurk-Burleson E, Hollis JM, et al. Treatment of the medial collateral ligament injury. I: The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am J Sports Med. Jan-Feb 1987;15(1):15-21. [Medline].

  14. Rettig A. Medial and lateral ligament injuries. In: Scott W, ed. Ligament and Extensor Mechanism Injuries of the Knee: Diagnosis and Treatment. St. Louis, Mo:. Mosby;1991.

  15. Shelbourne KD, Porter DA. Anterior cruciate ligament-medial collateral ligament injury: nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction. A preliminary report. Am J Sports Med. May-Jun 1992;20(3):283-6. [Medline].

  16. DeHaven KE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med. Jan-Feb 1980;8(1):9-14. [Medline].

  17. Hunter SC, Marascalco R, Hughston JC. Disruption of the vastus medialis obliquus with medial knee ligament injuries. Am J Sports Med. Nov-Dec 1983;11(6):427-31. [Medline].

  18. Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop. May 1978;(132):206-18. [Medline].

  19. Hughston JC, Andrews JR, Cross MJ. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. Mar 1976;58(2):159-72. [Medline].

  20. Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. Oct 1981;63(8):1257-69. [Medline].

  21. Reider B, Sathy MR, Talkington J. Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow-up study. Am J Sports Med. Jul-Aug 1994;22(4):470-7. [Medline].

  22. Ross G, Chapman AW, Newberg AR, Scheller AD Jr. Magnetic resonance imaging for the evaluation of acute posterolateral complex injuries of the knee. Am J Sports Med. Jul-Aug 1997;25(4):444-8. [Medline].

  23. Miyamoto RG, Bosco JA, Sherman OH. Treatment of medial collateral ligament injuries. J Am Acad Orthop Surg. Mar 2009;17(3):152-61. [Medline].

  24. Elsasser JC, Reynolds FC, Omohundro JR. The non-operative treatment of collateral ligaments of the knee in professional football players. J Bone Joint Surg. 1974;56A:1185-1190.

  25. Jokl P, Kaplan N, Stovell P, et al. Non-operative treatment of severe injuries to the medial and anterior cruciate ligaments of the knee. J Bone Joint Surg Am. Jun 1984;66(5):741-4. [Medline].

  26. Ranawat A, Baker CL 3rd, Henry S, Harner CD. Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg. Sep 2008;16(9):506-18. [Medline].

  27. Ricchetti ET, Sennett BJ, Huffman GR. Acute and chronic management of posterolateral corner injuries of the knee. Orthopedics. May 2008;31(5):479-88; quiz 489-90. [Medline].

  28. Swenson TM, Harner CD. Knee ligament and meniscal injuries. Current concepts. Orthop Clin North Am. Jul 1995;26(3):529-46. [Medline].

  29. Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med. Mar 31 2009;[Medline].

  30. Clancy WG. Repair and reconstruction of the posterior cruciate ligament. In: Chapman MW, ed. Operative Orthopedics. Philadelphia, Pa:. WB Saunders Co;1993.

  31. Noyes FR, Barber-Westin SD. Reconstruction of the lateral collateral ligament of the knee with patellar tendon allograft. Report of a new technique in combined ligament injuries. Am J Sports Med. Mar-Apr 1999;27(2):269-70. [Medline].

  32. Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG. Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy. Mar 2009;25(3):232-42. [Medline].

  33. Harner CD, Irrgang JJ, Paul J, et al. Loss of motion following anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20:507-515.

 
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