Collateral Under 2 Minutes Finance Strategists Your Online Finance Dictionary

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Dr. Ebraheim’s educational animated video describes injuries associated with the Medial Collateral Ligament – MCL. • The Medial Collateral Ligament is one of four major ligaments of the knee (MCL, LCL, PCL ACL). The Medial Collateral Ligament extend from the medial epicondyle of the femur to below the medial condyle of the tibia. The MCL is a static stabilizer composed of superficial (primary) and deep (secondary) portions that are restraints to valgus stress. • Superficial MCL • •Primary restraint to valgus stress. • •Proximal attachment: posterior aspect of medial femoral condyle. • •Distal attachment: metaphyseal region of the tibia about 5 cm distal to the joint lying beneath the pes anserinus. • Deep MCL • •Secondary restraints to valgus stress. • •Inserts directly into edge of tibial plateau and meniscus. • •May be separated from the superficial layer by a bursa. • The joined tendons of the Sartorius, gracilis, semitendinosus muscles cross on top of the lower part of the MCL. The pes anserine bursa is located anterior to the insertion of the medial collateral ligament to the tibia. The MCL’s primary function is to be a restraint to valgus stress. • The MCL is the most commonly injured ligament of the knee. The typical mechanism of injury of the MCL is due to a valgus and external rotation force. A typical blow to the knee usually causes complete rupture of the MCL. Rupture may occur proximally or distally. Tears of the proximal MCL have a greater healing rate. Tears of the distal MCL may not heal well (similar to Stener lesion of the thumb). • Associated conditions • •ACL tears: injury to ACL compromise up tp 90% of associated injuries. Rupture of the ACL causes anterolateral rotatory instability. The majority of MCL injuries that are associated with ACL injuries are grade III complete rupture, no end point with valgus stress at 30 degree and 0 degree of knee flexion. • •Meniscal tears: Up to 5% of isolated MCL injuries are associated with meniscal tears. Not a common injury. • Classification of MCL sprains • •Grade I: sprain, stretch injury • •Grade II: partial tear of the MCL. • •Grade III: complete tear of the ligament. No end point with valgus stress at 30 degree of knee flexion. • Presentation • History: pop sensation • Symptoms: pain and tenderness usually higher than the joint line. • Physical exam: tenderness along medial aspect of the knee, ecchymosis, knee effusion. • Testing for MCL injury • •Positive valgus stress test at 30 degree of knee flexion indicated injury to the superficial MCL. • •Opening around 1 cm indicated a grade III complete tear of the MCL • •Positive valgus stress test at 0 degrees of knee extension indicates posteromedial capsule or cruciate ligament injury in addition to MCL injury (means combined injury). • •Always evaluate for other injuries (ACL, PCL or medial meniscal tear). • Pellegrini-Steida syndrome • •Radiographs are usually normal however may show calcification at the medial femoral site (Pellegrini-Steida syndrome) • •Calcification due to chronic MCL deficiency at the medial femoral insertion site. • •Pediatric patient with a knee injury and suspected salter fracture should get stress views x-ray to rule out a growth plate injury. • •Growth plates are weaker than ligaments (may use MRI instead of stress views). • MRI is the study of choice as it identifies the location and extent of the MCL injury. • Treatment • •NSAIDS. • •Rest • •Therapy: minor sprain of the MCL require therapy with return to play in about a week. May use a brace if injury is grade II, return to play in about 2-4 weeks. With grade III injury, return to play in about 6-8 weeks. • •Surgery: surgery in grade III injuries with multiple ligament injury especially with distal avulsion fracture. If there is chronic instability with opening in full extension, do reconstruction. Additional arthroscopy may be needed to rule out associated injury. In combined MCL and ACL injuries, usually surgery for the ACL is delayed until the MCL heals (up to eight weeks). Use ACL brace. Complications include: stiffness and loss of motion. Laxity is associated with distal MCL injuries. Functional bracing may reduce an MCL injury in football players, particularly interior linemen. • Become a friend on facebook: • / drebraheim • Follow me on twitter: • https://twitter.com/#!/DrEbraheim_UTMC • Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: • https://www.utfoundation.org/foundati... • • Background music provided as a free download from YouTube Audio Library. • Song Title: Every Step

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