Spectrum of Medial Collateral Ligament Injury
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Posted by firstname.lastname@example.org, 3/29/04 at 10:53:48 AM.
MEDIAL COLLATERAL LIGAMENT(ANATOMY):
The medial collateral ligament is typically divided into the
superficial and deep bands. The superficial portion of the ligament
typically arises from the medial femoral condyle and passes distally to
insert approx. 5cm below the joint line and posterior to the pes
anserinus on the medial aspect of the proximal tibia. Superficial
fibers are separated from the deep fibers by a bursa.
The deep ligament is firmly attached to the capsule and the
midportion of the medial meniscus and attaches to the femur and tibia
adjacent to the joint. The medial collateral ligament is a stabilzer
that resists external rotation and anterior forces and is more often
injured than its lateral counterpart.
Click here for anatomy link for Medial Collateral Ligament anatomy from Wheeless' Textbook of Orthopaedics.
HOW DOES IT OCCUR?
This injury usually occurs when a blow to the outer side of the knee
causes stretching or tearing of the medial collateral ligament. It can
also be caused by twisting the knee. Specifically, the ligament is
injured due to a valgus stress with the knee in flexion.
TYPES OF MEDIAL COLLATERAL LIGAMENT INJURY(GRADE I-III):
Three appearances of the MCL with T2 Weighted Images.
I. A sprain, shows high T2 signal in the soft tissues medial to the MCL.
II. A severe sprain or partial tear, shows
high signal in the soft tissues medial to the MCL, but also has
high signal or partial disruption of the MCL itself. As well, there can
be thinning of the MCl itself.
III. A complete tear, shows complete disruption of the MCL.
Associated injuries of the capsule specifically
meniscocapsular separation, and can be diagnosed by noting fluid
between the MCL and the medial meniscus. Additionally, injuries of the
anterior cruciate ligament are also commonly seen with these injuries.
Commonly seen injury is so named the UNHAPPY TRIAD:
1. ANTERIOR CRUCIATE LIGAMENT TEAR
2. MEDIAL COLLATERAL LIGAMENT INJURY
3. MEDIAL MENISCUS TEAR
WHAT IS THE TREATMENT FOR A MEDIAL COLLATERAL LIGAMENT INJURY?
of a medial collateral ligament injury rarely requires surgical
intervention. Grade I sprains of the MCL usually resolve within a few
weeks. Resting from activity, icing the inury and the
use of anti-inflammatories will usually be all the treatment that is
When a grade II MCL sprain occurs, use of a hinged knee brace
is common in early treatment. Athletes with a grade II injury can
return to activity once they are not having pain over the MCL. When a
grade III injury occurs, patients usually wear a hinged knee brace and
protect weight-bearing with a gradual return to normal activities.
Patients with more severe injuries usually require physical therapy and
will not return to their full level of activity for 3 to 4 months.
- Agranoff AB, Kaplan RJ. Medial Collateral and Lateral Collateral Ligament Injury. EMedicine online.
- Medial Collateral Ligament. Wheeless' Textbook of Orthopaedics online