✅ Knee MRI Mastery/Chap 3.Collateral Ligaments

(Fig 3-A.10) Grade II MCL Injury and Reconstruction

MSK MRI 2024. 5. 5. 19:04

https://youtu.be/6jrGiw3ry40

https://youtu.be/GSIg93UH3Oc

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📌 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

 

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