Updated: 1/5/2018

Collateral Ligament Tear

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Questions
4
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Evidence
6
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Topic
Images
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  • Snapshot
    • A 22-year-old man presents to student health with severe knee pain. He was in soccer practice where an opposing team member struck his right leg laterally. He has developed pain since the event. On physical exam, anterior and posterior drawer test are negative. He has increased laxity with valgus stress and no laxity with varus stress to the knee.
  • Introduction
    • Collateral ligaments of the knee include the
      • lateral collateral ligament (LCL)
      • medial collateral ligament (MCL)
    • Function
      • both the lateral and medial collateral ligament are involved in stabilizing the knee
        • LCL
          • resists varus force on the knee
        • MCL
          • resists valgus force on the knee
  • Epidemiology
    • Incidence
      • MCL is most commonly injured knee ligament
  • ETIOLOGY
    • Pathogenesis
      • LCL
        • excessive varus force tears the LCL
      • MCL
        • excessive valgus force tears the MCL
  • Presentation
    • Symptoms
      • knee pain
    • Physical exam
      • increased laxity with valgus stress suggests an MCL injury
      • increased laxity with varus stress suggests an LCL injury
  • Imaging
    • Radiography
      • indication
        • initial imaging modality used to determine if a fracture is present
  • Studies
    • Making the diagnosis
      • a clinical diagnosis supported by imaging
  • Differential
    • Anterior cruciate ligament tear
      • differentiating factor
        • positive anterior drawer test
    • Posterior cruciate ligament tear
      • differentiating factor
        • positive posterior drawer test
  • Treatment
    • Conservative
      • physical therapy
        • indication
          • initial treatment for collateral ligament tears that are not severe
    • Operative
      • orthopedic surgery
        • indication
          • for severe collateral ligament tears
  • Complications
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Questions (4)

(M2.OR.17.4758) A 23-year-old male presents to his primary care physician after an injury during a rugby game. The patient states that he was tackled and ever since then has had pain in his knee. The patient has tried NSAIDs and ice to no avail. The patient has no past medical history and is currently taking a multivitamin, fish oil, and a whey protein supplement. On physical exam you note a knee that is heavily bruised. It is painful for the patient to bear weight on the knee, and passive motion of the knee elicits some pain. There is laxity at the knee to varus stress. The patient is wondering when he can return to athletics. Which of the following is the most likely diagnosis?

QID: 109013

Medial collateral ligament tear

12%

(8/67)

Lateral collateral ligament tear

78%

(52/67)

Anterior cruciate ligament tear

3%

(2/67)

Posterior cruciate ligament tear

0%

(0/67)

Meniscal tear

6%

(4/67)

M 6 D

Select Answer to see Preferred Response

(M2.OR.16.4690) A 45-year-old male comes into your office one week after he was tackled playing football with his friends. The patient states that the medial aspect of his knee collided with another player's knee. Since then, he has been taking ibuprofen for knee pain. On exam, the patient's right knee appears larger than his left knee with a small effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity on valgus stress test, but is very lax on varus stress test. Lachman's test and posterior drawer test both have firm endpoints without laxity. McMurray's test is positive and the patient states he feels catching and locking during the test. Which of the following structures has this patient injured in addition to the meniscus?

QID: 107587

Anterior cruciate ligament

0%

(0/14)

Posterior cruciate ligament

0%

(0/14)

Medial collateral ligament

0%

(0/14)

Lateral collateral ligament

100%

(14/14)

Medial patellofemoral ligament

0%

(0/14)

M 6 E

Select Answer to see Preferred Response

(M2.OR.16.4684) A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured?

QID: 107353

Posterior cruciate ligament

0%

(0/7)

Anterior cruciate ligament

0%

(0/7)

Medial collateral ligament

100%

(7/7)

Lateral collateral ligament

0%

(0/7)

Medial meniscus

0%

(0/7)

M 6 E

Select Answer to see Preferred Response

(M2.OR.15.59) A 17-year-old male presents to your office with right knee pain. He is the quarterback of his high school football team and developed the knee pain after being tackled in last night's game. He states he was running with the ball and was hit on the lateral aspect of his right knee while his right foot was planted. Now, he is tender to palpation over the medial knee and unable to bear full weight on the right lower extremity. A joint effusion is present and arthrocentesis yields 50 cc's of clear fluid. Which of the following exam maneuvers is most likely to demonstrate ligamentous laxity?

QID: 106386

Anterior drawer test

13%

(4/31)

Lachman's test

13%

(4/31)

Pivot shift test

3%

(1/31)

Valgus stress test

58%

(18/31)

Varus stress test

10%

(3/31)

M 6 E

Select Answer to see Preferred Response

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EXPERT COMMENTS (3)
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