Medial Collateral Ligament Injury; A New Classification Based on MRI and Clinical Findings. A Guide for Patient Selection and Early Surgical Intervention

Document Type: EDITORIAL

Authors

Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Medial collateral ligament (MCL)injury, is one of the most common ligament injuries of the knee,mostly results from a valgus force.Restoration of function and going back to the pre-injury level of function is the aim of treatment in ligament injuries of the knee. There are multiple soft tissue structures in medial side that play an important role in connection with each other to retain medial side stabilization and resists against valgus forces.MRI is now the most reliable and accurate investigation tool, this not only shows the exact site of the injury to the MCL, but also shows other ligament or soft tissue and bony injuries.we recommend a new classification of MCL injury classification based on pathoanatomy,MRI and clinical findings as a guide for patient selection and early surgical intervention.

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Main Subjects


1. Indelicato PA. Isolated medial collateral ligament
injuries in the knee. J Am Acad Orthop Surg. 1995;
3(1):9-14.
2. Shelbourne KD, Nitz PA. The O’Donoghue triad
revisited. Combined knee injuries involving anterior
cruciate and medial collateral ligament tears. Am J
Sports Med. 1991; 19(5):474-7.
3. Fetto JF, Marshall JL. Medial collateral ligament
injuries of the knee: a rationale for treatment. Clin
Orthop. 1978; 132(1):206-18.
4. Warren LF, Marshall JL. The supporting structures and
layers on the medial side of the knee: an anatomical
analysis. J Bone Joint Surg Am. 1979; 61(1):56-62.
5. Phisitkul P, James SL, Wolf BR, Amendola A. MCL
injuries of the knee: current concepts review. Iowa
Orthop J. 2006; 26(1):77-90.
6. LaPrade RF, Engebretsen AH, Ly TV, Johansen S,
Wentorf FA, Engebretsen L. The anatomy of the
medial part of the knee. J Bone Joint Surg Am. 2007;
89(9):2000-10.
7. Keyhani S, Mardani-Kivi M. Anatomical repair of
stener-like lesion of medial collateral ligament: a case
series and technical note. Arch Bone Jt Surg. 2017;
5(4):256-8.
8. Gordon BL. Standard nomenclature of athletic injuries.
Chicago: American Medical Association; 1968.
9. Hughston JC. The importance of the posterior oblique
ligament in repairs of acute tears of the medial
ligaments in knees with and without an associated
rupture of the anterior cruciate ligament. Results
of long-term follow-up. J Bone Joint Surg Am. 1994;
76(9):1328-44.
10. Chen L, Kim PD, Ahmad CS, Levine WN. Medial
collateral ligament injuries of the knee: current
treatment concepts. Curr Rev Musculoskelet Med.
2008; 1(2):108-13.
11. Hughston JC, Andrews JR, Cross MJ, Moschi A.
Classification of knee ligament instabilities. Part I. The
medial compartment and cruciate ligaments. J Bone
Joint Surg Am. 1976; 58(2):159-72.
12. Reider B, Sathy MR, Talkington J, Blyznak N, Kollias
S. Treatment of isolated medial collateral ligament
injuries in athletes with early functional rehabilitation.
A five-year follow-up study. Am J Sports Med. 1994;
22(4):470-7.
13. Indelicato PA, Hermansdorfer J, Huegel M.
Nonoperative management of complete tears
of the medial collateral ligament of the knee in
intercollegiate football players. Clin Orthop Relat Res.
1990; 256(1):174-7.
14. O’Donoghue DH. Surgical treatment of fresh injuries
to the major ligaments of the knee. 1950. Clin Orthop
Relat Res. 1991; 271(1):3-8.
15. Nakamura N, Horibe S, Toritsuka Y, Mitsuoka T,
Yoshikawa H, Shino K. Acute grade III medial collateral
ligament injury of the knee associated with anterior
cruciate ligament tear. The usefulness of magnetic
resonance imaging in determining a treatment
regimen. Am J Sports Med. 2003; 31(2):261-7.