Injuries to the Medial Collateral Ligament and Associated Medial Structures of the Knee

Abstract

*The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most commonly injured ligamentous structures of the knee. *The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament. *Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20 degrees and 30 degrees of knee flexion. *Because nonoperative treatment has a favorable outcome, there is a consensus that it should be the first step in the management of acute isolated grade-III injuries of the medial collateral ligament or such injuries combined with an anterior cruciate ligament tear. *If operative treatment is required, an anatomic repair or reconstruction is recommended.

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

“…Thus, we found important new knowledge about the individual biomechanical function and load sharing between these important medial knee structures. Importantly, we found the superficial medial collateral ligament was essentially comprised of two separate divisions, with the proximal division being more important to valgus stability and the distal division more important to providing external rotation stability to the knee [4,5,13].…”

“…The following rehabilitation guidelines are based on peer-reviewed published Level 5 guidelines [13]. Early ROM was stressed for an anatomic medial knee reconstruction so that intraarticular adhesions and quadriceps atrophy did not develop.…”

“…As part of the development of an anatomic medial knee reconstruction technique, we measured the forces present on the proximal and distal divisions of the superficial medial collateral ligament and the posterior oblique ligament to applied loads [5,13]. We believed it was important to perform this analysis so we could determine whether these loads could be duplicated in an anatomic reconstruction technique such that overconstraint of the reconstruction grafts would not occur.…”

The use of early immobilization in the management of acute soft-tissue injuries of the knee: results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons

“…For most acute soft-tissue knee injuries, complete immobilization is not required; if immobilization is used to alleviate pain and swelling, it should be of limited duration. [11][12][13][14][15][16] Patellar dislocation is arguably an exception, as is the grossly unstable knee. 1,[17][18][19][20] Management of these patients is undertaken in different clinical environments by various health care providers.…”

“…[33][34][35][36][37][38] Despite the need to consider each subcategory of injury as a unique entity, current evidence suggests that for most acute soft-tissue knee injuries (except grossly unstable knee injuries and patellar dislocations), complete immobilization is not required and its use should be limited. [11][12][13][14][15][16] Some authors suggest hinged knee braces be used to splint knees that are unstable in the coronal plane to provide protection to the healing tissues while allowing motion. 3,7,[9][10][11] In light of our results, there is a need for clarification and distribution of current recommendations.…”