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Medial Collateral and Lateral Collateral Ligament Injury Clinical Presentation

  • Author: Adam B Agranoff, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Jul 20, 2015
 

History

Listen to the patient's description of the injury event. The force vector of injury to the knee indicates the most likely site of pathology.[9] For example, a football player who complains of medial knee pain after a valgus stress on the knee is likely to have an injury to the medial collateral ligament (MCL). Have the patient use the uninjured knee to explain precisely what he/she was doing when the incident occurred.

  • MCL injury
    • Patients commonly have had recent excessive valgus force applied to a partially flexed knee (eg, a clipping injury in football). A common triad of injury (particularly in athletes) when a valgus force is applied to the knee involves injury to the MCL, the medial meniscus, and the anterior cruciate ligament.
    • Most patients are able to continue ambulating after an acute injury.
    • Pain and stiffness are localized to the medial knee.
    • Erythema may appear after several days.
    • The location of pain and swelling can be good indicators of which structure(s) may be damaged in the knee.
    • Instability or mechanical symptoms (eg, a locking or popping sensation) are uncommon.
  • Lateral collateral ligament (LCL) injury
    • The patient commonly reports a history of varus force applied to the knee.
    • Most patients are able to continue ambulating after an acute injury.
    • Pain and stiffness are localized to the lateral knee.
    • Erythema may appear after several days.
    • Swelling is often present.
    • Instability or mechanical symptoms (eg, a locking or popping sensation) are uncommon.
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Physical

Recognize that collateral ligament injuries often are seen in association with injury to other knee structures. A comprehensive musculoskeletal knee examination should be completed to direct further diagnostic testing and therapeutic interventions. A systematic review of the available literature revealed no articles that adequately assessed the diagnostic sensitivity and specificity of a physical examination in detecting medial and lateral collateral ligamentous injuries.

  • Medial collateral ligament (MCL) injury
    • Palpate with the knee in 25-30 º of flexion.
    • Tenderness may be noted anywhere along the course of the MCL.
    • Isolated tenderness at the proximal or distal insertion sites may indicate an avulsion-type injury.
    • Swelling often is present and should alert the examiner to possible intra-articular injury.
  • Lateral collateral ligament (LCL) injury
    • Palpate with the knee in 20 º of flexion.
    • Tenderness may be noted anywhere along the course of the LCL.
    • Isolated tenderness at the proximal or distal insertion sites may indicate an avulsion-type injury.
    • Swelling is common.
  • Evocative testing of collateral ligaments
    • Valgus stress testing of the MCL
      • The patient is in the supine position with the knee flexed 25-30 º. The examiner places one hand on the lateral knee and grasps the medial ankle with the other hand. Then the knee is abducted. Pain and excessive laxity indicate stretching or tearing of the MCL.
      • Perform the same technique as above with the knee extended. If excessive knee joint laxity and pain are still noted, injury to the anterior cruciate ligament also may be present.
    • Varus stress testing of the LCL
      • The patient is in the supine position with the knee flexed 20-25 º. The examiner places one hand on the medial knee and grasps the lateral ankle with other hand. The knee is adducted. Pain and excessive laxity indicate injury to the LCL.
      • Then perform the same technique as above with the knee extended. If pain and laxity are still present, injury to the posterior capsule may be present.
  • Injury severity
    • Grade I - Less than 5 cm laxity (partial tear)
    • Grade II - 5-10 cm laxity
    • Grade III - More than 10 cm laxity (complete tear)
  • Physical examination under general anesthesia may be indicated if the patient is guarding due to pain symptoms.
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Causes

See the list below:

  • Injury to the medial collateral ligament (MCL) or lateral collateral ligament (LCL) may be caused by the following:
    • Trauma
      • Acute varus or valgus stress on the knee joint
      • Sports related (younger population)
      • Falls (elderly)
      • Other trauma
    • Overuse syndromes (for example, swimmers who use the breaststroke may repetitively stretch the MCL, leading to injury)
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Contributor Information and Disclosures
Author

Adam B Agranoff, MD Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital

Adam B Agranoff, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Robert J Kaplan, MD Staff Physician, Department of Rehabilitation Medicine, James E Van Zandt VA Medical Center

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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The medial and lateral collateral ligaments of the knee. Courtesy of Randale Sechrest, MD, CEO, Medical Multimedia Group.
 
 
 
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