eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Medial Collateral and Lateral Collateral Ligament Injury: Differential Diagnoses & Workup

Author: Adam B Agranoff, MD, Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital
Coauthor(s): Robert J Kaplan, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine and Medical Center
Contributor Information and Disclosures

Updated: Jul 9, 2008

Differential Diagnoses

Patellofemoral Syndrome
Pes Anserinus Bursitis
Rheumatoid Arthritis
Tibial Plateau Fractures

Other Problems to Be Considered

Osteochondral fracture
Extensor mechanism rupture
Osteonecrosis of the femoral epicondyle
Osteonecrosis of the tibial condyle
Inflammatory conditions (systemic disease)

Workup

Laboratory Studies

  • Laboratory studies usually are not indicated for the diagnosis of a medial collateral ligament (MCL) or lateral collateral ligament (LCL) injury.

Imaging Studies

  • Diagnosis of a medial collateral ligament (MCL) or lateral collateral ligament (LCL) injury is usually clinical.7,10,11
  • Plain films in patients with suspected knee ligamentous injuries should include anteroposterior, lateral, intercondylar notch, and sunrise views. Avulsion fractures are often noted in knee ligament injuries. Indications for plain knee radiographs in suspected knee ligamentous injuries (Pittsburgh decision rules) are blunt trauma or a fall with one of the following criterion:
    • The patient is unable to walk 4 weight-bearing steps.
    • The patient is older than 50 years or younger than 12 years.
  • Magnetic resonance imaging (MRI) is helpful for ruling out other soft-tissue injuries (eg, anterior or posterior cruciate ligament tears, meniscus injury). MRI is very sensitive in detecting tears of the collateral ligaments. However, it is not reliable for differentiating grades of injury, and use of the modality can lead to underestimation of the degree of injury.12,13
    • The MCL can usually be visualized in its entirety in the coronal plane. A partial tear of the MCL is seen on T2-weighted MRI scans as an area of increased signal intensity, representing edema. The ligament may irregular. A complete tear of the MCL is marked by edema at the rupture site and retraction of the free ends.
    • The LCL is best visualized on coronal images. It tends to be of low signal intensity and have uniform thickness. Partial tears are characterized by edema. A complete LCL tear may be associated with a small avulsion of the styloid process of the fibular head and with marked edema.

Procedures

  • If an effusion is present, arthrocentesis of the knee may be indicated to rule out hemarthrosis.

More on Medial Collateral and Lateral Collateral Ligament Injury

Overview: Medial Collateral and Lateral Collateral Ligament Injury
Differential Diagnoses & Workup: Medial Collateral and Lateral Collateral Ligament Injury
Treatment & Medication: Medial Collateral and Lateral Collateral Ligament Injury
Follow-up: Medial Collateral and Lateral Collateral Ligament Injury
Multimedia: Medial Collateral and Lateral Collateral Ligament Injury
References
[ CLOSE WINDOW ]

References

  1. Fu FH, Harner CD, Johnson DL, et al. Biomechanics of knee ligaments: basic concepts and clinical application. Instr Course Lect. 1994;43:137-48. [Medline].

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

  3. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.

  4. Amiri S, Cooke D, Kim IY, et al. Mechanics of the passive knee joint. Part 2: interaction between the ligaments and the articular surfaces in guiding the joint motion. Proc Inst Mech Eng [H]. Nov 2007;221(8):821-32. [Medline].

  5. National Collegiate Athletic Association. NCAA Injury Surveillance System. 1999-2000;[Full Text].

  6. Yawn BP, Amadio P, Harmsen WS, et al. Isolated acute knee injuries in the general population. J Trauma. Apr 2000;48(4):716-23. [Medline].

  7. Quarles JD, Hosey RG. Medial and lateral collateral injuries: prognosis and treatment. Prim Care. Dec 2004;31(4):957-75, ix. [Medline].

  8. Dugan SA. Sports-related knee injuries in female athletes: what gives?. Am J Phys Med Rehabil. Feb 2005;84(2):122-30. [Medline].

  9. El-Dieb A, Yu JS, Huang GS, et al. Pathologic conditions of the ligaments and tendons of the knee. Radiol Clin North Am. Sep 2002;40(5):1061-79. [Medline].

  10. Pimentel L. Orthopedic trauma: office management of major joint injury. Med Clin North Am. Mar 2006;90(2):355-82. [Medline].

  11. Strayer RJ, Lang ES. Evidence-based emergency medicine/systematic review abstract. Does this patient have a torn meniscus or ligament of the knee?. Ann Emerg Med. May 2006;47(5):499-501. [Medline].

  12. Crotty JM, Monu JU, Pope TL Jr. Magnetic resonance imaging of the musculoskeletal system. Part 4. The knee. Clin Orthop Relat Res. Sep 1996;288-303. [Medline].

  13. Beall DP, Googe JD, Moss JT, et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Radiol Clin North Am. Nov 2007;45(6):983-1002, vi. [Medline].

  14. Hastings DE. The non-operative management of collateral ligament injuries of the knee joint. Clin Orthop. Mar-Apr 1980;(147):22-8. [Medline].

  15. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. Oct 2007;23(10):1066-72. [Medline].

  16. Wahl CJ, Nicandri G. Single-Achilles allograft posterior cruciate ligament and medial collateral ligament reconstruction: a technique to avoid osseous tunnel intersection, improve construct stiffness, and save on allograft utilization. Arthroscopy. Apr 2008;24(4):486-9. [Medline].

  17. Medvecky MJ, Zazulak BT, Hewett TE. A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete. Sports Med. 2007;37(2):169-87. [Medline].

  18. Yoshiya S, Kuroda R, Mizuno K, et al. Medial collateral ligament reconstruction using autogenous hamstring tendons: technique and results in initial cases. Am J Sports Med. Sep 2005;33(9):1380-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

medial collateral ligament injury, lateral collateral ligament injury, MCL injury, LCL injury, tibial collateral ligament, fibular collateral ligament

[ CLOSE WINDOW ]

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 and North American Spine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Robert J Kaplan, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine and Medical Center
Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, International Spine Intervention Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

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, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, 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, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.