Sprain, medial collateral ligament

• Tibial collateral ligament sprain

• 844.1 Sprain of medial collateral ligament of knee

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

• 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Bony or Soft Tissue Surgery

Description

• 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

Essentials of Diagnosis

• 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)

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

• 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

Functional Implications

• 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

Possible Contributing Causes

• Usually related to traumatic valgus stress applied to the knee2
  • Sports injury
  • Motor vehicle accident
• May be related to severe degenerative osteoarthrosis

Differential Diagnoses

• Medial joint line pain related to knee osteoarthrosis
• Pes anserine bursitis
• Adductor strain
• Patellofemoral pain syndrome
• Referred hip pain

Imaging

• MRI
• Valgus stress radiograph

• 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

• 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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