II. Mechanism
- Medial Collateral Ligament Rupture (common)
- Pure valgus load without rotation
- Force against lateral knee (in slight flexion)
- Common injury in Contact Sports (Football)
- Lateral Collateral Ligament Rupture (uncommon)
- Pure varus load without rotation
- Force against medial knee
- Rarely occurs without concurrent PCL or ACL injury
III. Signs
- See Knee Exam to evaluate associated injuries
- Localized collateral ligament signs
- Pain on palpation
- Localized Bruising or swelling
- Knee Valgus Stress Test evaluates MCL
- Knee Varus Stress Test evaluates LCL
IV. Grading: Ligamentous Sprain
- Grade 1 Injury: Minimal tear with no Joint Laxity
- Angle opening on stress: 0 to 5 mm
- Grade 2 Injury: Moderate tear with Joint Laxity
- Angle opening on stress: 6 to 10 mm
- Grade 3 Injury: Complete tear with no firm endpoint
- Angle opening on stress: 11 to 15 mm
V. Imaging: Knee XRay indicated in all suspected tears
- Views
- Anteroposterior
- Posteroanterior weight bearing
- Lateral
- Merchant view
- Findings: Chronic MCL insufficiency
- Calcific Medial Femoral Epicondyle (Pellegrini-Stieda Lesion)
- Findings: Chronic LCL insufficiency
VI. Imaging: Knee MRI Indications
- Persistent joint line pain 4-6 weeks after injury
VII. Differential Diagnosis
- Medial Collateral Ligament Injury
- Medial Collateral Ligament Tear
- Medial Meniscus Tear
- Pes Anserine Bursitis
- Plica Syndrome
- Calcific Medial Femoral Epicondyle (Pellegrini-Stieda Lesion)
- Stieda Fracture (bony avulsion Fracture of medial femoral condyle)
- Myositis Ossificans
- Knee Osteoarthritis
- Tendonitis (Semimembranosus, Semitendinosus)
- Slipped Capital Femoral Epiphysis (referred pain from hip in adolescents)
- Lateral Collateral Ligament Injury
- Knee Lateral Collateral Ligament Tear
- Lateral Meniscus Tear
- Iliotibial Band Syndrome
VIII. Course: MCL Healing
- Stage 1: Inflammation
- Onset within 3 days of injury
- Fibroblasts produce Type III Collagen
- Stage 2: Repair and Regeneration
- Stage 3: Remodeling
- Persists for more than 1 year after injury
- MCL regains 50-70% of elasticity, strength by 1 year
- Injury characteristics that slow healing
- Grade 3 sprains heal more slowly than Grades 1 and 2
- LCL tears heal more slowly than MCL tears
IX. Management
- RICE-M
- NSAIDs
- Local Cold Therapy
- Local Ultrasound or Phonophoresis
- Hinged Knee Brace
- Allows full flexion
- Limits terminal knee extension to 20 degrees
- Relative rest
- Grade 1 to 2
- Weight bearing as tolerated
- Grade 3
- Non-weight bearing initially
- Partial weight bearing by second week
- Full weight bearing by 4 weeks
- Grade 1 to 2
- Rehabilitation
- Surgical Indications
- Grade 3 Lateral Collateral Ligament tear
- Other concurrent knee Ligamentous Injury
X. Management: Return to play indications
- Functional Tests suggesting return to play
- One legged hopping
- Skipping rope
- Trampoline jumping
- Balance board (wobble board)
- Stair climbing
- Grade 1 to 2 MCL Sprain
- Anticipate return to play at 4-6 weeks after injury
- Return to forward Running at 60% of knee strength
- Return to sprinting at 80% of knee strength
- Return to contact at 90% of knee isokinetic strength
- Grade 3 MCL Sprain
- Anticipate return to play at 8-12 weeks after injury
- Criteria for return to play
- Isokinetic strength at 80%
- Adequate performance while sprinting
- Valgus stress tolerated without medial Knee Pain
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Related Studies
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, シツノガイソクソクフクジンタイノネンザ |
Czech | Podvrtnutí zevního postranního kolenního vazu |
Hungarian | Térd lateralis oldalszalag húzódása |
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, ヒザノナイソクソクフクジンタイノネンザ |
Czech | Podvrtnutí vnitřního postranního kolenního vazu |
Hungarian | Térd medialis oldalszalag húzódása |
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 |
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 |
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 |
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 |
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) |
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 |