Medial Collateral Ligament Syndrome

Abstract

Medial collateral ligament syndrome is characterized by pain at the medial aspect of the knee joint. This syndrome is usually the result of trauma to the medial collateral ligament from falls with the leg in valgus and externally rotated, typically during snow skiing accidents or football clipping injuries. The medial collateral ligament, which is also known as the tibial collateral ligament, is a broad, flat, bandlike ligament that runs from the medial condyle of the femur to the medial aspect of the shaft of the tibia, where it attaches just above the groove where the semimembranosus muscle attaches. It also attaches to the edge of the medial semilunar cartilage. The ligament is susceptible to strain at the joint line or avulsion at its origin or insertion. Patients with medial collateral ligament syndrome present with pain over the medial joint and increased pain on passive valgus and external rotation of the knee. Activity, especially flexion and external rotation of the knee, worsens the pain, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Patients with injury to the medial collateral ligament may complain of locking or popping with flexion of the affected knee. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint.

Keywords

medial collateral ligament syndrome, knee pain, medial collateral ligament, knee strain, ligament avulsion, Swain test, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection, joint laxity

ICD-10 CODE M23.50

The Clinical Syndrome

Medial collateral ligament syndrome is characterized by pain at the medial aspect of the knee joint. This syndrome is usually the result of trauma to the medial collateral ligament from falls with the leg in valgus and externally rotated, typically during snow skiing accidents or football clipping injuries ( Fig. 107.1 ). The medial collateral ligament, which is also known as the tibial collateral ligament, is a broad, flat, bandlike ligament that runs from the medial condyle of the femur to the medial aspect of the shaft of the tibia, where it attaches just above the groove where the semimembranosus muscle attaches ( Fig. 107.2 ). It also attaches to the edge of the medial semilunar cartilage. The ligament is susceptible to strain at the joint line or avulsion at its origin or insertion.

Signs and Symptoms

Patients with medial collateral ligament syndrome present with pain over the medial joint and increased pain on passive valgus and external rotation of the knee. Activity, especially flexion and external rotation of the knee, worsens the pain, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Patients with injury to the medial collateral ligament may complain of locking or popping with flexion of the affected knee. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint.

On physical examination, patients with injury to the medial collateral ligament exhibit tenderness along the course of the ligament from the medial femoral condyle to its tibial insertion. If the ligament is avulsed from its bony insertions, tenderness may be localized to the proximal or distal ligament, whereas patients suffering from strain of the ligament have more diffuse tenderness. Patients with severe injury to the ligament may exhibit joint laxity when valgus and varus stress is placed on the affected knee ( Fig. 107.3 ). The Swain test for medial collateral ligament injury may also be positive with significant injuries to the ligament ( Fig. 107.4 ). Because pain may produce muscle guarding, magnetic resonance imaging (MRI) of the knee may be necessary to confirm the clinical impression. Joint effusion and swelling may be present with injury to the medial collateral ligament, but these findings are also suggestive of intraarticular damage. Again, MRI can confirm the diagnosis.