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