[16] Medial Collateral Ligament Tear Flashcards

1
Q

What is the most commonly injured ligament of the knee?

A

The medial collateral ligament

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2
Q

What is the primary function of the MCL?

A

It acts as a valgus stabiliser of the knee

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3
Q

How is the MCL most commonly injured?

A

When external rotational forces are applied to the lateral knee, such as a football tackle impacting the outside of the knee

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4
Q

How can MCL injuries be graded?

A

From 1-3

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5
Q

What is a grade I MCL injury?

A

Mild injury, with minimally torn fibres and no loss of MCL integrity

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6
Q

What is a grade II MCL injury?

A

Moderate injury, with an incomplete tear and increased laxity of the MCL

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7
Q

What is a grade III MCL injury?

A

Severe injury, with a complete tear and gross laxity of the MCL

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8
Q

How does a MCL tear present?

A

The patient may report hearing a ‘pop’ with immediate medial joint line pain. Swelling tends to follow after a few hours

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9
Q

When does swelling follow a torn MCL within minutes?

A

If there is associated haemarthrosis

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10
Q

What will be found on examination with a torn MCL?

A
  • Increased laxity when testing the MCL
  • Extreme tenderness along the medial joint line, but may be able to weight bear
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11
Q

How is the MCL tested?

A

The valgus stress test

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12
Q

How can a grade II and III tear be distinguished clinically?

A

On medial stress testing - grade II is lax in 30 degrees of knee flexion, but solid in full extension. Grade III is lax in both positions

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13
Q

What are the main differentials to consider in a suspected MCL tear?

A
  • Fracture
  • Haemarthrosis
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14
Q

What investigations should be done in suspected MCL tear?

A
  • Plain film radiograph
  • MRI scanning
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15
Q

What is the purpose of x-rays in suspected MCL tear?

A

Exclude any fracture

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16
Q

What is the gold standard for diagnosing MCL tears?

A

MRI scanning

17
Q

What is the use of MRI scanning in MCL tear?

A

It delineates the exact extent and grade of the tear

18
Q

What is the management of an MCL injury dependant on?

A

The grade of injury

19
Q

How are grade I MCL tears managed?

A
  • RICE with analgesics is the mainstyle
  • Strength training as tolerated should be incorporated
20
Q

What analgesic is typically used in MCL tears?

A

NSAIDs

21
Q

What is the aim of strength training in grade I MCL injuries?

A

To return to full exercise within around 6 weeks

22
Q

How are grade III MCL tears managed?

A

Analgesia with knee brace and weight-bearing/strength training as tolerated

23
Q

How long should patients aim to take to return to full exercise in grade II MCL tears?

A

Around 10 weeks

24
Q

How are grade III MCL tears managed?

A

Analgesia with a knee brace and crutches

25
Q

When is surgery considered with grade III MCL tears?

A

If there is any associated distal avulsion

26
Q

How long should patients aim to take to return to full exercise after a grade III MCL tear?

A

Around 12 weeks

27
Q

What are the main complications following a MCL tear?

A
  • Instability in the joint
  • Damage to the saphenous nerve