eMedicine Specialties > Sports Medicine > Knee

Medial Collateral Knee Ligament Injury: Differential Diagnoses & Workup

Author: Thomas M DeBerardino, MD, Director, John A Feagin Jr West Point Sports Medicine Fellowship, Orthopedic Surgery Service, Clinical Instructor in Surgery, Keller Army Community Hospital at West Point
Coauthor(s): Jeffrey C Gundel, MD, Consulting Surgeon, Department of Orthopedic Surgery, North Country Sports Medicine
Contributor Information and Disclosures

Updated: May 30, 2006

Differential Diagnoses

Femur Injuries and Fractures

Other Problems to Be Considered

Medial meniscal tears
Patella subluxation
Patella dislocation
Tibial plateau fracture
Medial soft tissue contusion
Osteochondral fracture
Osteochondritis desiccans
Tibial plateau fracture
Medial hamstring strain
Pes bursitis
Medial retinacular strain and capsular tears

Workup

Imaging Studies

  • Radiography
    • Radiography should be performed to rule out fractures of the tibial plateau, patella, or distal femur. Osteochondral effects can also be observed. Anterior-posterior, lateral, and patellofemoral views are usually sufficient. In skeletally immature patients, stress views may be helpful in identifying an associated physeal injury.
    • The Pellegrini-Stieda lesion is indicative of an old injury and appears as a calcification at the femoral insertion of the MCL.
    • The lateral capsular sign, or Segond fracture, suggests an associated ACL tear. This is a chip of bone still attached to the capsule after the capsule is avulsed from the lateral tibia.
  • MRI: MRI is indicated when associated injuries are suspected. Associated ACL, PCL, and meniscal tears can be identified. Osteochondral fractures and bone bruises may also be identified. Injury of the MCL can be localized to the femoral, midsubstance, or tibial regions.
  • Diagnostic ultrasonography: Recent studies have suggested that diagnostic ultrasonography can be useful in evaluating MCL injuries.

Procedures

  • Joint aspiration: If a significant joint effusion is present, evaluation may be difficult. Using aseptic technique, the knee may be aspirated to allow for a more complete evaluation. A local anesthetic can be injected if the knee is too painful for evaluation.

More on Medial Collateral Knee Ligament Injury

Overview: Medial Collateral Knee Ligament Injury
Differential Diagnoses & Workup: Medial Collateral Knee Ligament Injury
Treatment & Medication: Medial Collateral Knee Ligament Injury
Follow-up: Medial Collateral Knee Ligament Injury
References
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References

  1. Albright JP, Powell JW, Smith W, et al. Medial collateral ligament knee sprains in college football. Effectiveness of preventive braces. Am J Sports Med. Jan-Feb 1994;22(1):12-8. [Medline].

  2. Fanelli GC, Edson CJ, Orcutt DR, et al. Treatment of combined anterior cruciate-posterior cruciate ligament-medial-lateral side knee injuries. J Knee Surg. Jul 2005;18(3):240-8. [Medline].

  3. Halinen J, Lindahl J, Hirvensalo E, Santavirta S. Operative and Nonoperative Treatments of Medial Collateral Ligament Rupture With Early Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study. Am J Sports Med. Feb 1 2006;[Medline].

  4. Lundberg M, Messner K. Long-term prognosis of isolated partial medial collateral ligament ruptures. A ten-year clinical and radiographic evaluation of a prospectively observed group of patients. Am J Sports Med. Mar-Apr 1996;24(2):160-3. [Medline].

  5. Lundberg M, Messner K. Ten-year prognosis of isolated and combined medial collateral ligament ruptures. A matched comparison in 40 patients using clinical and radiographic evaluations. Am J Sports Med. Jan-Feb 1997;25(1):2-6. [Medline].

  6. Reider B. Medial collateral ligament injuries in athletes. Sports Med. Feb 1996;21(2):147-56. [Medline].

  7. Reider B, Sathy MR, Talkington J, et al. 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].

  8. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am. Jan 1979;61(1):56-62. [Medline].

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Further Reading

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Keywords

MCL injury, tibial collateral knee ligament injury, TCL injury, torn ligament, knee injury

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Contributor Information and Disclosures

Author

Thomas M DeBerardino, MD, Director, John A Feagin Jr West Point Sports Medicine Fellowship, Orthopedic Surgery Service, Clinical Instructor in Surgery, Keller Army Community Hospital at West Point
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey C Gundel, MD, Consulting Surgeon, Department of Orthopedic Surgery, North Country Sports Medicine
Jeffrey C Gundel, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, Associate Professor, Departments of Neurological Surgery, Orthopedics, and Rehabilitation, University of Miami Miller School of Medicine
Andrew L Sherman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates
Disclosure: Nothing to disclose.

Chief Editor

Wylie D Lowery, Jr, MD, Department of Orthopedic Surgery, Associate Professor, George Washington University
Wylie D Lowery, Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Medical Society of Virginia, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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