Medial

• Medial collateral ligament:

  • Most commonly injured ligament of the knee
  • Primary function is to act as a valgus stabiliser
  • Medial collateral ligament injuries often occur in association with cruciate and meniscal injuries - should be excluded
• Mechanism of injury:

  • Usually from a direct blow to the lateral knee in a valgus stress direction e.g. contact sports or from valgus stress with external rotation force e.g. skiing
  • Injuries graded in severity from mild with minimally form fibres to severe with complete tear
• Presentation:

  • Patient may hear a pop with immediate medial joint line pain
  • Swelling follows within a few hours
• Exam findings:

  • Tenderness along course of the ligament (medial knee)
  • Tenderness along the medial joint line
  • May be able to weight bear
  • Effusion
  • Positive valgus stress test
• When and how to refer:

  • Suspect fracture if meets Ottawa knee rules - A+E for XR
  • Suspect significant soft tissue injury if meets criteria (knee pain after trauma with symptoms such as knee giving way, locking)
  • Suspect the soft tissue injury is an MCL injury based on history and examination findings
  • Would need review in line with local pathways e.g. A+E, fracture clinic, acute knee clinic
• Investigations:

  • MRI first line to establish diagnosis
• Management:

  • Rest, ice, compression, elevation
  • Analgesia - NSAIDs
  • Physiotherapy
  • Knee brace
  • Surgery