Stener-like lesion of the medial collateral ligament of the knee

Last revised by Fabio Macori on 26 Jun 2022

Stener-like lesions of the medial collateral ligament (MCL) occur when a tear involves the distal fibers of the superficial medial collateral ligament (sMCL) are displaced superficially to the pes anserinus, which can result in compromised healing.

Usually, the sMCL runs deep to the pes anserine. A Stener-like injury is characterized by the MCL's torn end moving to the surface in relation to the aponeurosis of the pes anserinus. This results in the interposition of the pes anserinus fibers between the two ends of the torn MCL. This situation prevents healing and surgical repair or reconstruction is necessary.

The diagnosis of a Stener-like lesion of the MCL relies heavily on MRI 1,2, as the clinical assessment of this lesion may be inconclusive. The field of view of the MRI must extend to the proximal tibial metadiaphysis, obtained by pivoting the knee joint line and utilizing a field of view of 16 cm. 

Stener-like lesions are most visible on coronal sequences, in which the proximal portion of the torn sMCL appears undulating, shortened, and medially dislocated. The torn proximal portion often borders the pes anserinus, which may cause the pes anserinus to be confused with the sMCL 2.

The term Stener lesion, also known as a skier's thumb or gamekeeper's thumb, was first utilized by Stener in 1962, referring to the disruption of the ulnar collateral ligament of the first metacarpophalangeal joint at the distal insertion with associated displacement on the adductor aponeurosis 3.  In 2010, surgeons Corten and Hoser described a similar injury involving the sMCL 4.

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