Medial collateral ligament injury of the knee

Last revised by Mona Hiba on 21 Jul 2023

Medial collateral ligament injuries of the knee comprise of sprains, partial and complete tears. Medial collateral ligament injuries are one of the most common ligamentous injuries of the knee.

Medial collateral ligament injuries are very common in athletes 1-4 and it is likely that many low-grade medial collateral ligament injuries are unreported 1.

Common risk factors for medial collateral ligament injury include both contact and non-contact sports such as:

  • football (soccer)

  • rugby / American football

  • martial arts

  • skiing

Usual complaints are medially located knee pain after acute trauma and the sensation of popping or giving way at the moment of injury. On a physical exam, a perceived medial joint opening in 30° flexion on valgus stress is indicative of a medial collateral ligament injury 1,4.

Medial collateral ligament injuries range from a minor sprain over partial tears to complete disruption. They can affect the superficial portion and/or deep portions of the medial collateral ligament 1,5.

Medial collateral ligament injury or tears are usually the results of valgus stress 1, but different mechanisms can result in characteristic associated injury patterns 5:

Most medial collateral ligament tears are proximal or distal.

Imaging in medial collateral injuries is usually done if multiple ligamentous injuries or associated meniscal tears are suspected 1.

Plain radiographs are of limited value, avulsion injuries of the femoral condyle can sometimes be seen. Rarely an avulsion injury of the meniscotibial component (coronary ligament) of the deep medial collateral ligament can be seen (reverse Segond fracture).

The most obvious sign of medial collateral ligament injury is its discontinuity in case of a partial or complete tear. Other signs include a wavy form of the ligament.

Injury of the deep portions of the medial collateral ligament is evident as high-signal intensity, swelling and discontinuity of the medial meniscofemoral and meniscotibial ligaments or an avulsion injury of the meniscotibial ligament (reverse Segond fracture).

Medial collateral ligament injuries can be graded on MRI according to the following grading scheme:

In addition, MRI allows the depiction of associated injuries as bone bruises, posterior oblique ligament and anterior cruciate ligament injuries as well as meniscal tears 5.

In case of medial collateral injury the report should include the following ref:

Grade 1, grade 2 and isolated grade 3 medial collateral ligament injuries are usually treated conservatively, including early mobilization and exercise therapy, taping, physical therapy, nonsteroidal anti-inflammatory drugs and orthotic management as a hinged knee brace.

Grade 1 and 2 injuries have usually favorable outcomes with a return to work/return to sport as early as after 10-20 days post-injury 1. Most grade 3 injuries (>75%) are associated with other ligamentous injuries, with anterior cruciate ligament injury being most common and therefore might need different management. But even in combined anterior cruciate/medial collateral ligament injuries ACL reconstruction after conservative medial collateral ligament injury management seems to be a widely accepted method 6,7. Surgical repair should be considered in chronic medial collateral ligament tears, bony avulsion injuries, and Stener-like lesions of the medial collateral ligament 1,8

It is important that the distal parts of the medial collateral ligament are captured within the field of view since many tears are located either proximal or distal.

Assessment of the superficial and deep portions of the medial collateral ligament superficial and posterior oblique ligament is usually done on coronal and axial images 5.

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