📌 Management of Acute MCL Injuries
- Grade I-II isolated MCL injuries should be managed non-operatively
- Even for grade III tears, initial non-operative treatment is preferred if ACL is intact
✅ Indications for Surgical Treatment
- Severe chronic pain and valgus instability despite conservative management
- Acute setting: superficial MCL torn from tibial insertion and displaced outside pes anserinus
➡️ Key Point 1: Concomitant Ligament Injuries
- If cruciate, deep capsular, or posteromedial corner injuries coexist, superficial MCL healing may fail
- This patient had ACL avulsion fracture and meniscofemoral ligament tear contributing to MCL healing failure
➡️ Key Point 2: MRI Grading vs Clinical Instability
- MRI grade may differ from clinical grade of instability
- Waviness of superficial MCL, deep MCL, ACL, posteromedial corner injuries correlate with clinical instability
- While MRI showed grade 2, valgus stress views revealed instability
Isolated Superficial MCL Tear
- May show valgus instability at 30° flexion but stability in extension (maintained by posterior oblique ligament)
Skeletal Radiology (2022) 51:1225–1233
Semin Musculoskelet Radiol. 2016 Feb;20(1):12-25
Am J Sports Med. 2009;37(9):1762-1770
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery"
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