Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Medial Collateral and Lateral Collateral Ligament Injury Treatment & Management

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

Rehabilitation Program

Physical Therapy

The type of physical therapy (PT) treatment indicated for a medial collateral ligament (MCL) injury depends on the severity of the injury.[7, 14] Recommendations for treatment include the following:

  • Grade I - Compression, elevation, and cryotherapy are recommended. Short-term use of crutches may be indicated, with weight-bearing–as–tolerated (WBAT) ambulation. Early ambulation is recommended.
  • Grade II - A short-hinged brace that blocks 20º of terminal extension but allows full flexion should be used. The patient may ambulate, WBAT. Closed-chain exercises allow for strengthening of knee musculature without putting stress on the ligaments.
  • Grade III - The patient initially should be non–weight-bearing (NWB) on the affected lower extremity. A hinged braced should be used, with gradual progression to full weight-bearing (FWB) over 4 weeks. Grade III injuries may require 8-12 weeks to heal.

All MCL injuries should be treated with early range of motion (ROM) and strengthening of musculature that stabilizes the knee joint. Conservative measures usually are adequate, but, if the patient fails to progress with treatment, a meniscal or cruciate ligament tear is suggested.

Lateral collateral ligament (LCL) injuries heal more slowly than do MCL injuries, due to the difference in collagen density. Recommendations for the treatment of LCL injuries include the following:

  • Grades I and II - These injuries are treated according to a regimen similar to that for MCL injuries of the same severity. A hinged brace is used for 4-6 weeks.
  • Grade III - Severe LCL injuries typically are treated surgically due to rotational instability, because they usually involve the posterolateral corner of the knee. Patients may require bracing and physical therapy for up to 3 months in order to prevent later instability.
Next

Surgical Intervention

Most patients with a collateral ligament injury can be treated effectively with conservative measures. Grade III lateral collateral ligament (LCL) tears usually involve the posterolateral complex and are associated with instability. These patients do require surgical repair.[15, 16, 17, 18, 19] Surgical treatment for isolated injuries of the medial collateral ligament (MCL) or LCL is a controversial topic. The treatment plan should be based partially on the patient's pre-injury level of activity and on motivational factors. For example, a young competitive swimmer may want surgery, followed by a comprehensive rehabilitation program to accelerate the time needed for adequate functional recovery.[20] A technique for repairing severe MCL injuries using autogenous hamstring tendons has been proposed.[21]

A study by Dong et al indicated that both anatomic ligament repair and triangular ligament reconstruction are about equally effective in the treatment of acute grade III MCL tear combined with anterior cruciate ligament (ACL) tear. The study, which involved 64 patients, had a mean 34-month follow-up period. Although International Knee Documentation Committee (IKDC) scores and evaluation of the medial opening of the knee showed no significant differences between the techniques, the investigators did find that patients who underwent triangular ligament reconstruction had a significantly lower incidence of anteromedial rotatory instability than did the anatomic ligament repair patients at final follow-up.[22]

Previous
Next

Consultations

An orthopedic surgery consultation is advised for individuals with severe ligament injury.

Previous
 
 
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.

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. 1995 Jul. 26(3):529-46. [Medline].

  3. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. 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]. 2007 Nov. 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. 2000 Apr. 48(4):716-23. [Medline].

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

  8. Dugan SA. Sports-related knee injuries in female athletes: what gives?. Am J Phys Med Rehabil. 2005 Feb. 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. 2002 Sep. 40(5):1061-79. [Medline].

  10. Pimentel L. Orthopedic trauma: office management of major joint injury. Med Clin North Am. 2006 Mar. 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. 2006 May. 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. 1996 Sep. 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. 2007 Nov. 45(6):983-1002, vi. [Medline].

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

  15. Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy. 2007 Oct. 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. 2008 Apr. 24(4):486-9. [Medline].

  17. Marx RG, Hetsroni I. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury. Clin Orthop Relat Res. 2012 Mar. 470(3):798-805. [Medline]. [Full Text].

  18. Schein A, Matcuk G, Patel D, Gottsegen CJ, Hartshorn T, Forrester D, et al. Structure and function, injury, pathology, and treatment of the medial collateral ligament of the knee. Emerg Radiol. 2012 Dec. 19(6):489-98. [Medline].

  19. Atoun E, Debbi R, Lubovsky O, Weiler A, Debbi E, Rath E. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release. Arthrosc Tech. 2013 Feb. 2(1):e41-3. [Medline]. [Full Text].

  20. 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].

  21. 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. 2005 Sep. 33(9):1380-5. [Medline].

  22. Dong J, Wang XF, Men X, et al. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction. Arthroscopy. 2015 Jun. 31 (6):1108-16. [Medline].

Previous
Next
 
The medial and lateral collateral ligaments of the knee. Courtesy of Randale Sechrest, MD, CEO, Medical Multimedia Group.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.