Fact-sheet: Sprain - Rupture of the tibial collateral ligament of the knee


Updated on 09/12/2019 at 1:56 PM

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Definition

Partial or complete post-traumatic tear of the medial collateral ligament fibers

Clinical features

Injury due to a forced valgus mechanism (involvement of the superficial then deep bundle)

Post-traumatic medial knee pain

Possibly associated with other meniscal or ligamentous injuries

Laboratory findings

Unremarkable

Radiography

In the acute phase:

  • Soft tissue thickening on the medial aspect of the Knee
  • Possible bony avulsion at the proximal insertion of the superficial bundle (Stieda fracture), the deep bundle, or the distal insertion of the deep bundle (reverse Segond fracture)
  • Impaction fracture of the tibial plateau
  • Spontaneous femorotibial gapping

In the chronic phase:

  • Residual calcification as part of Pellegrini-Stieda syndrome

Ultrasound

Assessment for partial tear (hypoechoic thickening) or complete tear (ligamentous discontinuity) of the ligament

Hematoma

Osteoperiosteal avulsion

Doppler hyperemia

CT

Assessment for bony avulsion or residual calcifications

MRI

Lesions primarily affect the proximal insertion of the MCL;
specify the location of the lesions (superficial/deep MCL) and their severity:

  • Grade 1 sprain: T2 hyperintense edema of the peri-ligamentous soft tissues, without fiber involvement
  • Partial tear (grade 2): intra- and peri-ligamentous signal abnormalities without complete discontinuity
  • Complete tear (grade 3): complete discontinuity of the MCL with, in the acute stage, extravasation of synovial fluid into the peri-ligamentous tissues

Associated findings:

  • Bone marrow edema at the MCL insertion
  • Mirror-image femorotibial edema on the lateral side

Chronic MCL injuries manifest as ligament thickening and occasionally ossification at its femoral insertion

Postoperatively, the MCL is thickened and may remain so for several years, with increased T2 signal.
Postoperative ossification may also develop

Management

Orthopedic and/or surgical management of associated lesions (central pivot, meniscus)

Isolated MCL lesion = surgical treatment most often not required

Classification

Clinical findings:

  • Grade 1: tear of a few fibers, no laxity
  • Grade 2: partial tear, moderate valgus laxity, but not in extension
  • Grade 3: complete tear, significant laxity on forced valgus in flexion but not in extension