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.




FIG 107.1


Medial collateral ligament syndrome is characterized by medial joint pain that is made worse with flexion or external rotation of the knee.



FIG 107.2


The medial collateral ligament is also known as the tibial collateral ligament.

(From Kang HS, Ahn JM, Resnick D. MRI of the extremities: an anatomic atlas . 2nd ed. Philadelphia: Saunders; 2002.)




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.




FIG 107.3


The valgus stress test for medial collateral ligament integrity.

(From Waldman SD. Physical diagnosis of pain: an atlas of signs and symptoms . 2nd ed. Philadelphia: Saunders; 2010:291.)



FIG 107.4


The Swain test for medial collateral ligament (MCL) injury. With the knee flexed to 90 degrees, the tibia is externally rotated when the knee is externally rotating in flexion, the collateral ligaments are tightened while the cruciates are relatively lax. Pain along the medial side of the joint indicates injury to the MCL complex. Many patients with chronic medial-sided laxity after injury have pain along the medial joint line with this maneuver. Pain along the medial side of the joint indicates medial collateral ligament complex injury.

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Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Medial Collateral Ligament Syndrome
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