Traumatic Injury of Medial Meniscotibial Ligament – Diagnostics and Conservative Treatment

2020 ◽  
Vol 62 (1) ◽  
pp. 60-66
Author(s):  
Kamil Zaworski ◽  
Gustaw Wójcik ◽  
Bartosz Rutowicz
Keyword(s):  
Conservative Treatment ◽  
Medial Collateral Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Traumatic Injury ◽  
Knee Injuries ◽  
Proximal Part ◽  
Diagnostic Methods ◽  
Collateral Ligament ◽  
Meniscotibial Ligament

The paper aims to present diagnostic methods and options of conservative treatment of traumatic injuries of medial meniscotibial ligament (MTL). Ca. 75% of all sport-related injuries pertains to the lower extremity; among those, knee damage the second most frequent, after ankle damage. The anteromedial part is where knee pain occurs most frequently. Knee injuries often lead to damage to ligament structures, including medial meniscotibial ligament, which is rarely reported in the literature. Those ligaments may be damaged when the knee is subject to forces leading to valgity and rotation of the femur, internally, and of the tibia, externally. Damage may be caused in an isolated manner, through overloads and combined microdamage. Medial meniscotibial ligaments are formed by a fibrous layer of the articular capsule and are a part of the deep medial collateral ligament. They run from the medial meniscus to the proximal part of the tibia. An MTL examination consists of three parts: medical interview, physical examination and additional examinations. Due to the structure of MTL, its diagnostics must be expanded by an examination of the anterior cruciate ligament (ACL), medial collateral ligament (MCL) and the medial meniscus. Treatment in the acute condition is carried out according to the PRICE (Protection, Rest, Ice, Compression, Elevation) rules. In the subacute and chronic condition, therapy may be expanded for instance by manual therapy methods, functional training, physical therapy and kinesiology taping.

scholarly journals Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ryo Murakami ◽  
Eisaburo Honda ◽  
Atsushi Fukai ◽  
Hiroki Yoshitomi ◽  
Takaki Sanada ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Knee Dislocation ◽  
Single Stage ◽  
Lateral Condyle ◽  
Ligament Repair ◽  
Collateral Ligament ◽  
Medial Condyle

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

scholarly journals Tibial Avulsion with Intra-Articular Entrapment of Medial Collateral Ligament with Posterior Cruciate Ligament Tear with Posterior Root Medial Meniscus Tear: A Case Report of an Unusual Injury Triad

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ishan Shevate ◽  
Girish Nathani ◽  
Ashwin Deshmukh ◽  
Anirudh Kandari
Keyword(s):  
Case Report ◽  
Medial Collateral Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Stress Test ◽  
Joint Line ◽  
Posterior Root ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Medial Knee

Introduction: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint; however, its displacement into the medial knee compartment is rare. Traumatic posterior root of medial meniscus (PRMM) tears are commonly found in high-grade injuries involving anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears along with MCL tears. Diagnosis of these injuries can be made by a preoperative magnetic resonance imaging (MRI), but they can be missed at times due to severe soft-tissue swelling in the acute phase. Case Report: A 25-year-old gentleman presented with injury to the front of his left knee 5 days back. On examination, he had a Grade 3 effusion with valgus stress test and posterior drawer test being positive and medial joint line tenderness was present. A firm localized swelling was palpable on the medial joint line. MRI scan revealed a mid-substance PCL tear, ACL sprain, PRMM tear, and tibial side rupture of superficial MCL with proximally migrated wavy MCL fibers lying below the medial meniscus confirmed on arthroscopy. Medial meniscus root repair by pull through technique and PCL reconstruction with a 3-strand peroneus longus graft followed by open MCL repair with augmentation using a semitendinosus graft was performed. Postoperatively, the knee was kept in a straight knee brace for 4 weeks, followed by a hinged knee brace and appropriate physiotherapy were started. At 2 years follow-up, the patient had attained full range of knee motion with good quadriceps strength, tibial step off maintained, and negative posterior drawer test and valgus stress test. Displacement of torn MCL into the medial knee compartment is an extremely rare injury. Proximal or distal avulsion of MCL with intra-articular incarceration has been reported in isolation or associated with ACL tear. Such an injury triad as reported here has not been reported in the literature to the best of our review. Conclusion: In our case, we report a ver

scholarly journals Psychological Rehabilitation From Anterior Cruciate Ligament–Medial Collateral Ligament Reconstructive Surgery: A Case Study

2009 ◽  
Vol 2 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Siobhain McArdle
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Traumatic Injury ◽  
Situational Factors ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Psychological Response ◽  
Anterior Cruciate

Background: Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. Hypothesis/Purpose: An 18-year-old male scholarship soccer player who, owing to a perceived deliberate injurious tackle by an opposition player, tore the medial collateral ligament and anterior cruciate ligament of his right knee. A psychological case perspective is presented. Study Design: Retrospective case report. Results: Various personal and situational factors can compound negative psychological response to injury. A number of extreme responses are explored, including posttraumatic stress, depression, and fear of reinjury. Conclusions: Practitioners should be willing and able to facilitate referral in the instance of more extreme psychological response to anterior cruciate ligament injury.

scholarly journals IS PERCUTANEOUS MEDIAL COLLATERAL LIGAMENT (MCL) RELAXATION DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION A SAFE OPTION FOR GAINING ACCESS TO THE MEDIAL KNEE COMPARTMENT IN CHILDREN?

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
John A. Schlechter ◽  
Tanner Harrah ◽  
Bryn Gornick ◽  
Benjamin Sherman
Keyword(s):  
Anterior Cruciate Ligament ◽  
Children And Adolescents ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Adult Population ◽  
Deep Infection ◽  
Patient Reported Outcome ◽  
Collateral Ligament ◽  
Patient Reported ◽  
Anterior Cruciate

Introduction: With participation in youth sports anterior cruciate ligament (ACL) injuries are a common occurrence. Nearly 70% of ACL tears in children and adolescents have an associated meniscus tear. Percutaneous medial collateral ligament (MCL) relaxation has been described as utilitarian in accessing the medial meniscus for diagnostic assessment and treatment in the adult population to increase medial compartment working space in arthroscopic surgery. The technique has not been evaluated in the pediatric population. The purpose of this study was to compare the outcomes of children and adolescents that underwent anterior cruciate ligament reconstruction (ACLR) with and without percutaneous relaxation of the medial collateral ligament (MCL) for meniscal tear management. Methods: A retrospective review was performed of patients aged 8 to 19 years old that had undergone knee arthroscopy for an (ACLR) with meniscus pathology. Those that underwent MCL relaxation were grouped together and compared to a matched cohort that did not have MCL relaxation performed. Preoperative, operative and postoperative data was analyzed. The primary measurement was obtained using a validated patient reported outcome score (Pedi-IKDC), secondary outcome measures were defined as superficial or deep infection, saphenous nerve dysesthesias, ACL graft failure and return to the operating room. Statistical analysis of the two cohorts was performed. Results: Fifty-four patients were included in the study (27 in each group) with average age 15 years (range 10-19). Average follow-up for the MCL relaxation group was 22.4 months versus 58 months for the non-MCL relaxation group. The average Pedi-IKDC score was 93.3 for the MCL relaxation group and 91.4 for the non-MCL relaxation group (p=0.34). There was no difference in patient demographics, return to the operating room (p=0.49), saphenous nerve dysesthesia (p=0.49), superficial or deep infection (p=0.32). Conclusion: ACL reconstruction in children and adolescents with MCL relaxation for the management of medial meniscal tears appears to be a safe option. Equivocal patient reported outcome scores as compared to the control group were found with no increase in post-operative complications. In children with ACL tears, appropriate diagnosis and management of medial meniscal pathology is important to maintain secondary restraint to anterior tibial translation and prevent premature graft failure. Pediatric knees can have tight medial compartments, making access difficult, potentially leading to poor visualization and iatrogenic chondral damage. Percutaneous medial collateral ligament (MCL) relaxation has been described in the adult population to increase medial compartment working space without long term sequela. We report similar findings in an all pediatric cohort.

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

2003 ◽  
Vol 31 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Norimasa Nakamura ◽  
Shuji Horibe ◽  
Yukiyoshi Toritsuka ◽  
Tomoki Mitsuoka ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Superficial Layer ◽  
Ligament Injury ◽  
Resonance Imaging ◽  
Collateral Ligament ◽  
Medial Collateral Ligament Injury ◽  
Anterior Cruciate ◽  
Grade Iii

Background: The appropriate management of acute grade III medial collateral ligament injury when it is combined with a torn anterior cruciate ligament has not been determined. Hypothesis: Magnetic resonance imaging grading of grade III medial collateral ligament injury in patients who also have anterior cruciate ligament injury correlates with the outcome of their nonoperative treatment. Study Design: Prospective cohort study. Methods: Seventeen patients were first treated nonoperatively with bracing. Eleven patients with restored valgus stability received anterior cruciate ligament reconstruction only, and six with residual valgus laxity also received medial collateral ligament surgery. Results: Magnetic resonance imaging depicted complete disruption of the superficial layer of the medial collateral ligament in all 17 patients and disruption of the deep layer in 14. Restoration of valgus stability was significantly correlated with the location of superficial fiber damage. Damage was evident over the whole length of the superficial layer in five patients, and all five patients had residual valgus laxity despite bracing. Both groups had good-to-excellent results 5 years later. Conclusions: Location of injury in the superficial layer may be useful in predicting the outcome of nonoperative treatment for acute grade III medial collateral ligament lesions combined with anterior cruciate ligament injury.

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