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Posterior cruciate ligament
0%
0/7
Anterior cruciate ligament
Medial collateral ligament
100%
7/7
Lateral collateral ligament
Medial meniscus
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The 20-year-old male presents with laxity present on valgus stress test in his right knee with negative Lachman's and posterior drawer tests. This is most likely due to a sprain of the medial collateral ligament (MCL). A patient that is hit on the lateral aspect of his knee faces a valgus force that causes damage to the MCL. In this setting, the patient has no effusion or swelling, so this is most likely a sprain instead of a complete tear of the ligament. Patients with MCL sprains may experience some instability of the knee, but the most common presentation of MCL sprains is pain on the medial aspect of the knee with effusions and swelling more common with ligamentous tears. Smith et al. discusses the diagnosis of knee injuries and recommend the use of MRI not only to confirm physical maneuvers as mentioned above, but also to diagnose soft tissue and neurovascular injuries which might prompt more immediate surgical intervention. Additionally, they also recommend the use of RICE (rest, ice, compression, and elevation) along with anti-inflammatory drugs (such as NSAIDs) for the first 24-72 hours. Interestingly, Levy et al. notes that when MCL tears occur concurrently with tears of the ACL or PCL (multiligamentous injuries), patients face a worse outcome both over the short and over the long-term with respect to pain and functional ability. They also note people who are older (specifically over the age of 30 years), do worse with higher failure rates of surgical repair than younger patients. In an additional randomized controlled trial by Wright et al, it was found that smoking decreased the biomechanical strength and stiffness of MCLs in mice causing early tears. Incorrect Answers: Answer 1 and 2: Anterior cruciate and posterior cruciate ligament injuries would present with positive Lachman's and posterior drawer tests, respectively. Answer 4: Lateral collateral ligament injuries would present with a laxity on the varus stress test. Answer 5: Meniscus tears normally present with locking, catching, and popping sensations and have a positive McMurray's test.
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