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Condition/Disorder Synonyms

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  • Tibial collateral ligament sprain

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ICD-9-CM Code

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  • 844.1 Sprain of medial collateral ligament of knee

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ICD-10-CM Code

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  • S83.419A Sprain of medial collateral ligament of unspecified knee, initial encounter

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Preferred Practice Pattern1

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Key Features

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Description

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  • Tear of the medial collateral ligament of the knee

  • May be graded based on extent of damage1,2

    • Grade I: localized tenderness with no instability

    • Grade II: localized tenderness, moderate fiber disruption; slight to moderate abnormal motion

    • Grade III: Complete fiber disruption; noted instability

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Essentials of Diagnosis

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  • Injury is generally traumatic and can occur at any age

  • Trauma is usually a high impact force applied to the lateral knee

  • The anterior cruciate ligament (ACL) and medial meniscus are commonly injured concurrently

  • Clinical diagnosis is generally made through history of injury and knee valgus stability testing

  • Diagnosis may be confirmed with magnetic resonance imaging (MRI)

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General Considerations

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  • Medial collateral ligament is most taut in knee extension

  • Commonly injured from an outside force hitting the lateral portion of the knee, ie. football tackle

  • Anterior fibers of superficial band is taut with flexion2

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Demographics

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  • Most commonly injured knee ligament

  • Incidence (United States)2

    • Average 0.24 per 1000

    • Male = 0.36 per 1000, female = 0.18 per 1000

  • Most common in young athletic population

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Clinical Findings

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Signs and Symptoms

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  • Medial knee pain

  • Pain with palpation over medial knee

  • Pain with valgus force to knee

  • Pain with extension and deep flexion

  • Feeling of instability or “giving way” in the knee

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Functional Implications

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  • Decreased squatting ability

  • Difficulty with transitioning from sit-to-stand or stand-to-sit

  • Pain with swinging legs in/out of car and/or bed

  • Decreased stability while walking on uneven surfaces

  • Decreased stability with change of direction

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Possible Contributing Causes

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  • Usually related to traumatic valgus stress applied to the knee2

    • Sports injury

    • Motor vehicle accident

  • May be related to severe degenerative osteoarthrosis

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Differential Diagnoses

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  • Medial joint line pain related to knee osteoarthrosis

  • Pes anserine bursitis

  • Adductor strain

  • Patellofemoral pain syndrome

  • Referred hip pain

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI

  • Valgus stress radiograph

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Findings and Interpretation

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  • Valgus stress radiograph

    • Isolated injury of superficial MCL Increased medial gapping of 1.7 mm at 0˚ knee flexion

    • Increased medial gapping of 3.2 mm at 20˚ knee flexion

  • Complete injury of MCL

    • Increased ...

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