Medial collateral ligament knee injury
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Synopsis
Causes / typical injury mechanism: The medial knee consists of a complex of layered capsular and ligamentous structures that includes the medial collateral ligament (MCL) and posterior oblique ligament, both of which provide resistance to valgus stress on the knee. The MCL has 2 main components: the superficial MCL and the deep MCL. The MCL is one of the most commonly injured ligaments of the knee, involved in approximately 20% of knee injuries. Injury frequently results from either direct valgus pressure to the knee or abduction / rotation of the lower leg in relation to the thigh, resulting in a sprain or tear of the MCL.Classic history and presentation: Patients will often present acutely with pain and swelling of the medial aspect of the knee, often with point tenderness at the femoral insertion (medial epicondyle) of the MCL. Some patients report a popping or tearing sensation at the time of injury. Mild MCL injuries may not result in significant valgus laxity, but patients with more severe lesions often report instability with lateral and pivoting maneuvers. Significant instability may indicate the involvement of additional surrounding structures or other knee ligaments being compromised (multiligamentous knee injury).
Prevalence: Contact and collision sports (wrestling, hockey, soccer, football, skiing, etc) are frequently implicated; therefore, MCL injuries frequently occur in younger, active populations.
- Age – Teenage years to fifth decade
- Sex/gender – MCL injuries predominantly affect men more than women
- Grade 1 – Less than 5 mm
- Grade 2 – 5-9 mm
- Grade 3 – 10 mm or more
Codes
ICD10CM:M23.639 – Other spontaneous disruption of medial collateral ligament of unspecified knee
SNOMEDCT:
444448004 – Injury of medial collateral ligament of knee
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Differential Diagnosis & Pitfalls
- Posterolateral corner (PLC) injury
- Anterior cruciate ligament (ACL) injury
- Meniscal injury
- Tendinous injury – The semimembranosus, semitendinosus, gracilis, sartorial, medial gastrocnemius, quadriceps, and patellar tendons all insert medially on the tibia. Tendonitis of any of these structures could present with medial knee pain.
- Bursitis – Pes anserine or semimembranosus bursae, prepatellar or postpatellar bursitis.
- Epiphyseal injury – Distal femoral or proximal tibial epiphysis.
- Knee arthritis
- Fractures – Tibial plateau and distal femur fractures.
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Last Reviewed:11/16/2020
Last Updated:01/30/2022
Last Updated:01/30/2022
Medial collateral ligament knee injury