Medial Collateral Knee Ligament Injury Workup

  • Author: Thomas M DeBerardino, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 30, 2012
 

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.[4]
    • The Pellegrini-Stieda lesion is indicative of an old injury and appears as a calcification at the femoral insertion of the MCL.[4]
    • 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.[4]
    • Stress radiography is a useful adjunct for confirming the grade of MCL injury. Valgus stress radiographs have been shown to accurately and reliably measure medial compartment opening. Differentiation between either meniscofemoral- and meniscotibial-based injuries was noted to be difficult. When comparing with the normal opposite knee at 20° of flexion, a grade III MCL injury is suspected if greater than 3.2 mm of medial compartment opening is noted. Valgus stress radiographs provide objective and reproducible measurements of medial compartment opening.[5]
  • Magnetic resonance imaging (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.[1]
  • Diagnostic ultrasonography: Studies have suggested that diagnostic ultrasonography can be useful in evaluating MCL injuries.
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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.
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Contributor Information and Disclosures
Author

Thomas M DeBerardino, MD  Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds None; Musculoskeletal Transplant Foundation Grant/research funds None; Histogenics Grant/research funds None; Advanced Biomedical Technologies Stock Options Medical Director, North America

Coauthor(s)

Jeffrey C Gundel, MD  Consulting Surgeon, Department of Orthopedic Surgery, Glen Falls Hospital; Consulting Surgeon, Department of Orthopedic Surgery, Saratoga Hospital

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.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, 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: Pfizer Honoraria Speaking and teaching

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

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Chahal J, Al-Taki M, Pearce D, et al. Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study. Knee Surg Sports Traumatol Arthrosc. Dec 15 2009;[Medline].

  2. Griffith CJ, LaPrade RF, Johansen S, et al. Medial knee injury: part 1, static function of the individual components of the main medial knee structures. Am J Sports Med. Sep 2009;37(9):1762-70. [Medline].

  3. Wijdicks CA, Griffith CJ, LaPrade RF, et al. Medial knee injury: part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med. Sep 2009;37(9):1771-6. [Medline].

  4. Laprade RF, Bernhardson AS, Griffith CJ, et al. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med. Dec 4 2009;[Medline].

  5. Laprade RF, Bernhardson AS, Griffith CJ, Macalena JA, Wijdicks CA. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med. Feb 2010;38(2):330-8. [Medline].

  6. Lind M, Jakobsen BW, Lund B, et al. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med. Jun 2009;37(6):1116-22. [Medline].

  7. 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].

  8. 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].

  9. 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.

  10. 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].

  11. 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].

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

  13. 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].

  14. 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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