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.^[6]

The Pellegrini-Stieda lesion is indicative of an old injury and appears as a calcification at the femoral insertion of the MCL.^[6]

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.^[6]

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.^[7]

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.^[2]

A systematic review by Meyer et al showed that the correlation of MRI findings with physical examination findings was moderate to strong (65-92%) in patients with MCL injuries. In addition, MRI was more sensitive than physical examination in identifying MCL lesions.^[8]

Diagnostic ultrasonography

Studies have suggested that diagnostic ultrasonography can be useful in evaluating MCL injuries.

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.

Treatment & Management

Roach CJ, Haley CA, Cameron KL, Pallis M, Svoboda SJ, Owens BD. The epidemiology of medial collateral ligament sprains in young athletes. Am J Sports Med. 2014 May. 42(5):1103-9. [QxMD MEDLINE Link].
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. 2009 Dec 15. [QxMD MEDLINE Link].
Lundblad M, Hägglund M, Thomeé C, et al. Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee Surg Sports Traumatol Arthrosc. 2019 Nov. 27 (11):3692-8. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Sep. 37(9):1762-70. [QxMD MEDLINE Link].
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. 2009 Sep. 37(9):1771-6. [QxMD MEDLINE Link].
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. 2010 Feb. 38 (2):330-8. [QxMD MEDLINE Link].
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. 2010 Feb. 38(2):330-8. [QxMD MEDLINE Link].
Meyer P, Reiter A, Akoto R, et al. Imaging of the medial collateral ligament of the knee: a systematic review. Arch Orthop Trauma Surg. 2022 Dec. 142 (12):3721-36. [QxMD MEDLINE Link].
Dale KM, Bailey JR, Moorman CT 3rd. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee. Clin Sports Med. 2017 Jan. 36 (1):87-103. [QxMD MEDLINE Link].
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. 2009 Jun. 37(6):1116-22. [QxMD MEDLINE Link].
Pandey V, Khanna V, Madi S, Tripathi A, Acharya K. Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction. Injury. 2017 Jun. 48 (6):1236-1242. [QxMD MEDLINE Link].
Albright JP, Powell JW, Smith W, et al. Medial collateral ligament knee sprains in college football. Effectiveness of preventive braces. Am J Sports Med. 1994 Jan-Feb. 22(1):12-8. [QxMD MEDLINE Link].
Fanelli GC, Edson CJ, Orcutt DR, et al. Treatment of combined anterior cruciate-posterior cruciate ligament-medial-lateral side knee injuries. J Knee Surg. 2005 Jul. 18(3):240-8. [QxMD MEDLINE Link].
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. 2006 Jul. 34 (7):1134-40. [QxMD MEDLINE Link].

Media Gallery

The medial and lateral collateral ligaments of the knee. Courtesy of Randale Sechrest, MD, CEO, Medical Multimedia Group

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Author

Thomas M DeBerardino, MD, FAAOS, FAOA Professor of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine; Professor of Orthopaedic Surgery and Faculty of Sports Medicine Fellowship, Baylor College of Medicine; Sports Medicine Orthopaedic Surgeon, Department of Orthopaedics, UT Health San Antonio; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder

Thomas M DeBerardino, MD, FAAOS, FAOA is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Clinical Orthopaedic Society, Herodicus Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; MTF; Aesculap; Conmed; JRF<br/>Received research grant from: Arthrex, Inc.; MTF.

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.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

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, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.