Medial Collateral ligament

• Composed of 2 components : superficial (tight in flexion) and deep (tight in extension)

• Results from excessive valgus stress on the knee, is often an isolated injury and can be managed nonoperatively in the majority of patients 

• Frequent pathology

• Valgus stress is the most common mechanism of injury (usually with the knee held in slight flexion and external rotation)

• Associated lesions

  • ACL ( especially with complete tear of MCL)

  • Medial meniscus

  • Pelligrini-Stieda syndrome (calcification of the femoral end if chronic MCL deficiency)

• Clinical presentation

  • POP during the accident

  • medial knee pain with ecchymosis , oedema

  • medial gapping as compared to opposite knee indicates grade of injury

    • 1- 4 mm = grade I

    • 5-9 mm = grade II

    • > or equal to 10 mm = grade III

  • If Valgus induced gapping is present while the knee is in extension : Think of associated injury: posteromedial capsule or cruciate ligament injury

Imaging

• Xrays + Valgus stress bilateral

• MRI

Treatment

• NSAIDs, Ice therap, rest : grade 1

• Bracing : isloated grade 2 and 3. Distal MCL injuries have less healing potential than proximal injuries

• Operative :

  • If associated injury (Complexe ligament tear knee)

  • entrapment of the torn end in the medial compartment

  • Stenner type lesion

  • In the acute setting, prefer reinsertion. In the chronic case, prefer reconstruction