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  • Tibial collateral ligament sprain

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  • 844.1 Sprain of medial collateral ligament of knee

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

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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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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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Imaging

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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 medial joint gapping of 6.5 mm at 0˚ knee flexion

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  • Possible referral to physician for pain management
  • Possible referral for MRI if questionable diagnosis or if meniscus injury or tibial plateau fracture is suspected
  • Possible referral for knee brace

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  • Decreased knee range of motion
  • Muscle guarding
  • Acutely decreased ...

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