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Medial Collateral and Lateral Collateral Ligament Injury Workup

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

Laboratory Studies

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

Imaging Studies

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  • 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.


See the list below:

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

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.


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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