Medial collateral ligament injury - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Medial collateral ligament injury occurs when excessive valgus stresses or external rotation forces are placed on the knee joint.
The most common symptom is medial-sided knee pain above or below the joint line. Patients are usually able to walk.
Diagnosis and grading is primarily made with history taking and physical exam.
Most patients are treated nonoperatively.
Prognosis for isolated medial collateral ligament injuries is good. Most patients return to sports within 3 to 6 weeks and to preinjury levels within 3 months.

Medial collateral ligament (right knee)

Created by Sanjeev Bhatia, MD; used with permission

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History & Exam
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Medial collateral ligament (right knee)
The abduction (valgus) stress test
The anterior drawer test
The Lachman test
Anterior knee anatomy (right knee), patella removed
Oblique view of medial knee (right knee). MCL: medial collateral ligament
Diagnostic algorithm for medial collateral ligament injuries. RICE: rest, ice, compression, elevation
X-ray indications in acute knee injury: the Ottawa knee rules
T2-weighted MRI showing a medial collateral ligament injury
X-ray indications in acute knee injury: the Ottawa knee rules
Hinged knee brace

Citations

Key Articles

O'Donoghue DH. An analysis of end results of surgical treatment of major injuries to the ligaments of the knee. J Bone Joint Surg. 1955 Jan;37-A(1):1-13.[Abstract]
American Medical Association, Committee on the Medical Aspects of Sports. Standard nomenclature of athletic injuries. Physical Therapy. 1969 Nov;49(11):1323.[Full Text]
Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res. 1978 May;(132):206-18.[Abstract]
Warren RF, Marshall JL. Injuries of the anterior cruciate and medial collateral ligaments of the knee. A long-term follow-up of 86 cases - part II. Clin Orthop Relat Res. 1978 Oct;(136):198-211.[Abstract]
Phisitkul P, James SL, Wolf BR, et al. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006 Feb;26:77-90.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: acute trauma to the knee. 2019 [internet publication].[Full Text]
Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010 May;92(5):1266-80.[Abstract]
Halinen J, Lindahl J, Hirvensalo E, et al. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2006 Jul;34(7):1134-40.[Abstract]
Marchant MH Jr, Tibor LM, Sekiya JK, et al. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med. 2011 May;39(5):1102-13.[Abstract]
Giannotti BF, Rudy T, Graziano J. The non-surgical management of isolated medial collateral injuries of the knee. Sports Med Arthrosc. 2006 Jun;14(2):74-7.[Abstract]

Other Online Resources

Knee exam (9 of 27): inspection & palpation: supine
Knee exam (14 of 27): MCL

Referenced Articles

1. O'Donoghue DH. An analysis of end results of surgical treatment of major injuries to the ligaments of the knee. J Bone Joint Surg. 1955 Jan;37-A(1):1-13.[Abstract]
2. American Medical Association, Committee on the Medical Aspects of Sports. Standard nomenclature of athletic injuries. Physical Therapy. 1969 Nov;49(11):1323.[Full Text]
3. Makhmalbaf H, Shahpari O. Medial collateral ligament injury; a new classification based on MRI and clinical findings. A guide for patient selection and early surgical intervention. Arch Bone Jt Surg. 2018 Jan;6(1):3-7.[Abstract][Full Text]
4. Slocum DB, Larson RL, James SL. Late reconstruction procedures used to stabilize the knee. Orthop Clin North Am. 1973 Jul;4(3):679-89.[Abstract]
5. Fetto JF, Marshall JL. Medial collateral ligament injuries of the knee: a rationale for treatment. Clin Orthop Relat Res. 1978 May;(132):206-18.[Abstract]
6. Hughston JC, Barrett GR. Acute anteromedial rotator instability. Long-term results of surgical repair. J Bone Joint Surg Am. 1983 Feb;65(2):145-53.[Abstract]
7. Warren RF, Marshall JL. Injuries of the anterior cruciate and medial collateral ligaments of the knee. A long-term follow-up of 86 cases - part II. Clin Orthop Relat Res. 1978 Oct;(136):198-211.[Abstract]
8. Abbot LC, Saunders JB, Bost FC, et al. Injuries to ligaments of the knee joint. J Bone Joint Surg. 1944 Jul 1;26:503-21.
9. Andrews K, Lu A, Mckean L, et al. Review: Medial collateral ligament injuries. J Orthop. 2017 Aug 15;14(4):550-54.[Abstract][Full Text]
10. Meyers MC, Barnhill BS. Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study. Am J Sports Med. 2004 Oct-Nov;32(7):1626-38.[Abstract]
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13. Gardiner JC, Weiss JA, Rosenberg TD. Strain in the human medial collateral ligament during valgus loading of the knee. Clin Orthop Relat Res. 2001 Oct;(391):266-74.[Abstract]
14. Weiss JA, Woo SL, Ohland KJ, et al. Evaluation of a new injury model to study medial collateral ligament healing: primary repair versus nonoperative treatment. J Orthop Res. 1991 Jul;9(4):516-28.[Abstract]
15. Hughston JC, Andrews JR, Cross MJ, et al. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976;58:159-172.[Abstract]
16. Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. 2006 Jun;14(2):105-10.[Abstract]
17. Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Arthrosc. 2006 Jun;14(2):58-66.[Abstract]
18. Phisitkul P, James SL, Wolf BR, et al. MCL injuries of the knee: current concepts review. Iowa Orthop J. 2006 Feb;26:77-90.[Abstract][Full Text]
19. Indelicato P, Linton R. Medial ligament injuries in the adult. In: DeLee J, Drez, D, Miller MD, eds. DeLee & Drez's orthopaedic sports medicine. 2nd ed. Philadelphia, PA: WB Saunders; 2003:1938-49.
20. Garvin GJ, Munk PL, Vellet AD. Tears of the medial collateral ligament: magnetic resonance imaging findings and associated injuries. Can Assoc Radiol J. 1993 Jun;44(3):199-204.[Abstract]
21. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med. 2004 Mar;32(2):337-45.[Abstract]
22. Donaldson WF 3rd, Warren RF, Wickiewicz T. A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med. 1985 Jan-Feb;13(1):5-10.[Abstract]
23. Laprade RF, Bernhardson AS, Griffith CJ, et al. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med. 2010 Feb;38(2):330-8.[Abstract]
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25. Meyer P, Reiter A, Akoto R, et al. Imaging of the medial collateral ligament of the knee: a systematic review. Arch Orthop Trauma Surg. 2022 Dec;142(12):3721-36. [Abstract][Full Text]
26. Shelbourne KD, Martini DJ, McCarroll JR, et al. Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears. Am J Sports Med. 1995 Mar-Apr;23(2):166-9.[Abstract]
27. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults - an evidence-based approach. Part 1. Lower extremity disorders. J Manipulative Physiol Ther. 2007 Nov-Dec;30(9):684-717.[Abstract]
28. Corea JR, Moussa M, al Othman A. McMurray's test tested. Knee Surg Sports Traumatol Arthrosc. 1994;2(2):70-2.[Abstract]
29. Chahla J, Kunze KN, LaPrade RF, et al. The posteromedial corner of the knee: an international expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):2976-86.[Abstract][Full Text]
30. American College of Radiology. ACR appropriateness criteria: acute trauma to the knee. 2019 [internet publication].[Full Text]
31. Logerstedt DS, Snyder-Mackler L, Ritter RC, et al. Knee stability and movement coordination impairments: knee ligament sprain. J Orthop Sports Phys Ther. 2010 Apr;40(4):A1-A37.[Abstract][Full Text]
32. Rue JPH, Lewis PB, Detterline AJ, et al. Minimally invasive medial collateral ligament reconstruction using Achilles tendon allograft. Tech Knee Surg. 2007;6:266-73.
33. Azar FM. Evaluation and treatment of chronic medial collateral ligament injuries of the knee. Sports Med Arthrosc. 2006 Jun;14(2):84-90.[Abstract]
34. Mook WR, Miller MD, Diduch DR, et al. Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation. J Bone Joint Surg Am. 2009 Dec;91(12):2946-57.[Abstract]
35. Woo SL, Young EP, Ohland KJ, et al. The effects of transaction of the anterior cruciate ligament on healing of the medial collateral ligament: a biomechanical study of the knee in dogs. J Bone Joint Surg Am. 1990 Mar;72(3):382-92.[Abstract]
36. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010 May;92(5):1266-80.[Abstract]
37. Halinen J, Lindahl J, Hirvensalo E, et al. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2006 Jul;34(7):1134-40.[Abstract]
38. Marchant MH Jr, Tibor LM, Sekiya JK, et al. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med. 2011 May;39(5):1102-13.[Abstract]
39. Grant JA, Tannenbaum E, Miller BS, et al. Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy. 2012 Jan;28(1):110-22.[Abstract]
40. Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009 Apr;25(4):430-8.[Abstract]
41. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review. Sports Med Arthrosc. 2011 Jun;19(2):167-73.[Abstract]
42. Giannotti BF, Rudy T, Graziano J. The non-surgical management of isolated medial collateral injuries of the knee. Sports Med Arthrosc. 2006 Jun;14(2):74-7.[Abstract]
43. Guenther D, Pfeiffer T, Petersen W, et al.Treatment of combined injuries to the ACL and the MCL complex: a consensus statement of the Ligament Injury Committee of the German Knee Society (DKG). Orthop J Sports Med. 2021 Nov 29;9(11):23259671211050929.[Abstract][Full Text]
44. Lundberg M, Messner K. Ten-year prognosis of isolated and combined medial collateral ligament ruptures: a matched comparison in 40 patients using clinical and radiographic evaluations. Am J Sports Med. 1997 Jan-Feb;25(1):2-6.[Abstract]
45. Lundberg M, Messner K. Long-term prognosis of isolated partial medial collateral ligament ruptures: a ten-year clinical and radiographic evaluation of a prospectively observed group of patients. Am J Sports Med. 1996 Mar-Apr;24(2):160-3.[Abstract]