Collateral Ligament Tear of Knee

Aka: Collateral Ligament Tear of Knee, Knee Collateral Ligament Injury, Knee Collateral Ligament Sprain, Knee Lateral Collateral Ligament Tear, Knee Medial Collateral Ligament Tear, Knee Medial Collateral Ligament Injury, Knee Lateral Collateral Ligament Injury, Knee LCL Tear, Knee MCL Tear, Knee Lateral Collateral Ligament Rupture, Knee Medial Collateral Ligament Rupture, Knee Medial Collateral Ligament Sprain, Knee Lateral Collateral Ligament Sprain

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II. Mechanism

  1. Medial Collateral Ligament Rupture (common)
    1. Pure valgus load without rotation
    2. Force against lateral knee (in slight flexion)
    3. Common injury in Contact Sports (Football)
  2. Lateral Collateral Ligament Rupture (uncommon)
    1. Pure varus load without rotation
    2. Force against medial knee
    3. Rarely occurs without concurrent PCL or ACL injury

III. Signs

  1. See Knee Exam to evaluate associated injuries
  2. Localized collateral ligament signs
    1. Pain on palpation
    2. Localized Bruising or swelling
  3. Knee Valgus Stress Test evaluates MCL
  4. Knee Varus Stress Test evaluates LCL

IV. Grading of Ligamentous Sprain

  1. Grade 1 Injury: Minimal tear with no Joint Laxity
    1. Angle opening on stress: 0 to 5 mm
  2. Grade 2 Injury: Moderate tear with Joint Laxity
    1. Angle opening on stress: 6 to 10 mm
  3. Grade 3 Injury: Complete tear with no firm endpoint
    1. Angle opening on stress: 11 to 15 mm

V. Radiology: Knee XRay indicated in all suspected tears

  1. Views
    1. Anteroposterior
    2. Posteroanterior weight bearing
    3. Lateral
    4. Merchant view
  2. Findings: Chronic MCL insufficiency
    1. Calcific medial femoral epicondyle (Pellegrini-Stieda
    2. Findings: Chronic LCL insufficiency
      1. Chip Fracture of fibular head
      2. Differentiate from Segond sign (ACL Tear)

VI. Radiology: Knee MRI Indications

  1. Persistent joint line pain 4-6 weeks after injury

VII. Course of MCL Healing

  1. Stage 1: Inflammation
    1. Onset within 3 days of injury
    2. Fibroblasts produce Type III collagen
  2. Stage 2: Repair and Regeneration
    1. Onset 6 weeks after injury
    2. Type I collagen replaces Type III collagen
  3. Stage 3: Remodeling
    1. Persists for more than 1 year after injury
    2. MCL regains 50-70% of elasticity, strength by 1 year
  4. Injury characteristics that slow healing
    1. Grade 3 sprains heal more slowly than Grades 1 and 2
    2. LCL tears heal more slowly than MCL tears

VIII. Management

  1. RICE-M
  2. NSAIDs
  3. Local Cold Therapy
  4. Local Ultrasound or Phonophoresis
  5. Hinged Knee Brace
    1. Allows full flexion
    2. Limits terminal knee extension to 20 degrees
  6. Relative rest
    1. Grade 1 to 2
      1. Weight bearing as tolerated
    2. Grade 3
      1. Non-weight bearing initially
      2. Partial weight bearing by second week
      3. Full weight bearing by 4 weeks
  7. Rehabilitation
    1. Quadriceps strengthening Exercises
    2. Knee range of motion Exercises
  8. Surgical Indications
    1. Grade 3 Lateral Collateral Ligament tear
    2. Other concurrent knee Ligamentous Injury

IX. Management: Return to play indications

  1. Functional Tests suggesting return to play
    1. One legged hopping
    2. Skipping rope
    3. Trampoline jumping
    4. Balance board (wobble board)
    5. Stair climbing
  2. Grade 1 to 2 MCL Sprain
    1. Anticipate return to play at 4-6 weeks after injury
    2. Return to forward Running at 60% of knee strength
    3. Return to sprinting at 80% of knee strength
    4. Return to contact at 90% of knee isokinetic strength
  3. Grade 3 MCL Sprain
    1. Anticipate return to play at 8-12 weeks after injury
    2. Criteria for return to play
      1. Isokinetic strength at 80%
      2. Adequate performance while sprinting
      3. Valgus stress tolerated without medial Knee Pain

X. References

  1. Indelicato (1990) Clin Orthop Relat Res, (256):174-7 [PubMed]
  2. Kakarlapudi (2001) West J Med 174:266-72 [PubMed]
  3. Meislin (1996) Phys Sportsmed, 24(3):67-80 [PubMed]
  4. Reider (1994) Am J Sports Med 22(4):470-7 [PubMed]

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Related Studies

Ontology: Sprain of lateral collateral ligament of knee (C0160080)

Concepts Injury or Poisoning (T037)
ICD9 844.0
ICD10 S83.42
SnomedCT 157292002, 35726004
English Sprain of lateral collateral ligament of knee joint, Sprn lat collat lig knee joint, sprain of lateral collateral ligament of knee (diagnosis), sprain of lateral collateral ligament of knee, Sprain lateral coll lig, Sprain of lateral collateral ligament of knee joint (disorder), Sprain of lateral collateral ligament of knee, Sprain of lateral collateral ligament of knee (disorder)
Dutch verstuiking van lateraal collateraal knieligament
French Entorse du ligament collatéral externe du genou
German Verstauchung des lateralen Kollateralbands des Knies
Italian Distorsione legamento collaterale esterno del ginocchio
Portuguese Lesão do ligamento lateral externo do joelho
Spanish Esguince del ligamento colateral externo de la rodilla, esguince del ligamento colateral externo de la rodilla (trastorno), esguince del ligamento colateral externo de la rodilla, esguince de ligamento lateral externo de rodilla, estrema del ligamento colateral externo de la rodilla, esguince de ligamento lateral externo de rodilla (trastorno)
Japanese 膝の外側側副靱帯の捻挫, ｼﾂﾉｶﾞｲｿｸｿｸﾌｸｼﾞﾝﾀｲﾉﾈﾝｻﾞ
Czech Podvrtnutí zevního postranního kolenního vazu
Hungarian Térd lateralis oldalszalag húzódása
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sprain of medial collateral ligament of knee (C0160081)

Concepts Injury or Poisoning (T037)
ICD9 844.1
ICD10 S83.41
SnomedCT 157293007, 209518002, 81902001
English Sprain of medial collateral ligament of knee joint, Sprn med collat lig knee joint, sprain of medial collateral ligament of knee, knee sprain MCL, sprain of medial collateral ligament of knee (diagnosis), Sprain medial collat lig, Sprain of medial collateral ligament of knee joint (disorder), Sprain of medial collateral ligament of knee, Sprain of medial collateral ligament of knee (disorder)
Dutch verstuiking van mediaal collateraal knieligament
French Entorse du ligament collatéral interne du genou
German Verstauchung des medialen Kollateralbands des Knies
Italian Distorsione legamento collaterale mediale del ginocchio
Portuguese Lesão do ligamento lateral interno do joelho
Spanish Esguince del ligamento colateral interno de la rodilla, esguince de ligamento lateral interno de rodilla, esguince de ligamento lateral interno de rodilla (trastorno), estrema del ligamento colateral medial de la rodilla, esguince del ligamento colateral interno de la rodilla (trastorno), estrema del ligamento colateral interno de la rodilla, esguince del ligamento colateral interno de la rodilla, esguince del ligamento colateral medial de la rodilla
Japanese 膝の内側側副靱帯の捻挫, ﾋｻﾞﾉﾅｲｿｸｿｸﾌｸｼﾞﾝﾀｲﾉﾈﾝｻﾞ
Czech Podvrtnutí vnitřního postranního kolenního vazu
Hungarian Térd medialis oldalszalag húzódása
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Rupture of medial collateral ligament of knee (C0409320)

Concepts Injury or Poisoning (T037)
SnomedCT 239729004
English MCL - Med collat lig rupt knee, Rupture med collat lig knee, Tear med collat lig knee joint, MCL - Medial collateral ligament rupture of the knee, Rupture of medial collateral ligament of knee, Tear of medial collateral ligament of knee joint, Rupture of medial collateral ligament of knee (disorder)
Spanish ruptura del ligamento lateral interno de la rodilla (trastorno), ruptura del ligamento lateral interno de la rodilla
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Rupture of lateral collateral ligament of knee (C0435133)

Concepts Injury or Poisoning (T037)
SnomedCT 263140001, 239731008
English LCL - Lat collat lig rupt knee, Rupture lat collat lig knee, Rupture of the lateral collateral ligament of the knee, Tear lat collat lig knee joint, LCL - Lateral collateral ligament rupture of the knee, Rupture of lateral collateral ligament of knee, Tear of lateral collateral ligament of knee joint, Rupture of lateral collateral ligament of knee (disorder)
Spanish ruptura del ligamento lateral externo de la rodilla (trastorno), ruptura del ligamento lateral externo de la rodilla
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sprain and strain of unspecified collateral ligament (C0840712)

Concepts Injury or Poisoning (T037)
ICD10 S83.40
English Sprain and strain of unspecified collateral ligament
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Injury of collateral ligament of knee (C2732312)

Concepts Injury or Poisoning (T037)
SnomedCT 444159004
English Injury of collateral ligament of knee (disorder), Injury of collateral ligament of knee
Spanish lesión traumática de ligamento lateral de rodilla (trastorno), lesión traumática de ligamento lateral de rodilla
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Injury of medial collateral ligament of knee (C2732313)

Concepts Injury or Poisoning (T037)
SnomedCT 444448004
English Injury of medial collateral ligament of knee, Injury of medial collateral ligament of knee (disorder)
Spanish lesión traumática de ligamento lateral interno de rodilla, lesión traumática de ligamento lateral interno de rodilla (trastorno)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Injury of lateral collateral ligament of knee (C2732839)

Concepts Injury or Poisoning (T037)
SnomedCT 444468005
English Injury of lateral collateral ligament of knee (disorder), Injury of lateral collateral ligament of knee
Spanish lesión traumática de ligamento lateral externo de rodilla (trastorno), lesión traumática de ligamento lateral externo de rodilla
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Knee Disorders

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