MCL and LCL Injuries
Normal Anatomy
Normal Anatomy
Mechanism of Injury
MCL• Valgus stress• Most commonly s-MCL• d-MCL injuries rare
although possible with only low grade s-MCL injuries
LCL• Severe, high-energy,
direct varus stress• Uncommon due to
relative flexibility of LCL and decreased incidence of lateral stress
ClassificationGrade 1• Clinical - Local pain on no significant gapping on varus / valgus stress• MRI - Microscopic tears of individual fibers with associated swelling
Grade 2• Clinical – Broader area of pain, significant gapping on varus / valgus
stress with firm end feel• MRI - Macroscopic partial tears with high signal in the ligament or
morphological changes on MRI
Grade 3• Clinical – No definitive end point on varus / valgus stress• MRI - Complete ligamentous discontinuity
Associated Pathologies
• ACL injuries• PCL injuries• Avulsion fractures• Medial meniscus tears• Meniscocapsular separations• Bone bruising
Subjective
• History of varus / valgus or rotational stress injury
• Pain over lateral or medial knee• Instant swelling• Pain when weight bearing
Objective
• Pain on palpation of injured site• MCL – Pain end of range flexion• Varus / valgus stress painful and/or laxity– Grade I – No movement– Grade II – 3-5mm joint opening– Grade III - >5mm joint opening
Special Tests
• Varus stress test (LCL)• Valgus stress test (MCL)
Further Investigation
• Varus / valgus stress radiographs• MRI• Ultrasound imaging
Management
Conservative
• Grade I-II injuries• Isolated s-MCL grade III
injuries
Surgery
• Isolated grade III injuries which do not respond to conservative management
• Grade III injuries with associated pathology
Conservative - Management• Decrease weight bearing to allow pain free ambulation• Hinged knee brace to prevent varus / valgus stress• Maintain full ROM• Maintain quads strength• Maintain adductor strength (adductor longus insertion lies
in close proximity to MCL) • Progress to full weight bearing once limp has disappeared• Stationary bike as soon as tolerated (has been shown to
improve healing times)• Return to play within 3 weeks (mild injuries) or 5-10 weeks
(severe injuries)
Conservative – Management - Mild
Conservative – Management- Severe
Surgical - Management
• Reconstruction– MCL: Two separate grafts, four insertions