[16] Medial Collateral Ligament Tear Flashcards
What is the most commonly injured ligament of the knee?
The medial collateral ligament
What is the primary function of the MCL?
It acts as a valgus stabiliser of the knee
How is the MCL most commonly injured?
When external rotational forces are applied to the lateral knee, such as a football tackle impacting the outside of the knee
How can MCL injuries be graded?
From 1-3
What is a grade I MCL injury?
Mild injury, with minimally torn fibres and no loss of MCL integrity
What is a grade II MCL injury?
Moderate injury, with an incomplete tear and increased laxity of the MCL
What is a grade III MCL injury?
Severe injury, with a complete tear and gross laxity of the MCL
How does a MCL tear present?
The patient may report hearing a ‘pop’ with immediate medial joint line pain. Swelling tends to follow after a few hours
When does swelling follow a torn MCL within minutes?
If there is associated haemarthrosis
What will be found on examination with a torn MCL?
- Increased laxity when testing the MCL
- Extreme tenderness along the medial joint line, but may be able to weight bear
How is the MCL tested?
The valgus stress test
How can a grade II and III tear be distinguished clinically?
On medial stress testing - grade II is lax in 30 degrees of knee flexion, but solid in full extension. Grade III is lax in both positions
What are the main differentials to consider in a suspected MCL tear?
- Fracture
- Haemarthrosis
What investigations should be done in suspected MCL tear?
- Plain film radiograph
- MRI scanning
What is the purpose of x-rays in suspected MCL tear?
Exclude any fracture
What is the gold standard for diagnosing MCL tears?
MRI scanning
What is the use of MRI scanning in MCL tear?
It delineates the exact extent and grade of the tear
What is the management of an MCL injury dependant on?
The grade of injury
How are grade I MCL tears managed?
- RICE with analgesics is the mainstyle
- Strength training as tolerated should be incorporated
What analgesic is typically used in MCL tears?
NSAIDs
What is the aim of strength training in grade I MCL injuries?
To return to full exercise within around 6 weeks
How are grade III MCL tears managed?
Analgesia with knee brace and weight-bearing/strength training as tolerated
How long should patients aim to take to return to full exercise in grade II MCL tears?
Around 10 weeks
How are grade III MCL tears managed?
Analgesia with a knee brace and crutches
When is surgery considered with grade III MCL tears?
If there is any associated distal avulsion
How long should patients aim to take to return to full exercise after a grade III MCL tear?
Around 12 weeks
What are the main complications following a MCL tear?
- Instability in the joint
- Damage to the saphenous nerve
