Medial Collateral Ligament Syndrome

THE CLINICAL SYNDROME

Patients with medial collateral ligament syndrome will present with pain over the medial joint and increased pain on passive valgus and external rotation of the knee. Activity, especially involving flexion and external rotation of the knee, will make the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The patient with injury to the medial collateral ligament may complain of locking or popping with flexion of the affected knee. The pain may interfere with sleep. Coexistent bursitis, tendinitis, arthritis, and/or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint.

The medial collateral ligament syndrome is characterized by pain at the medial aspect of the knee joint. It is usually the result of trauma to the medial collateral ligament from falls with the leg in valgus and externally rotated, typically during snow skiing accidents or football clipping injuries. The medial collateral ligament is a broad, flat bandlike femur to the medial aspect of the shaft of the tibia, where it attaches just above the groove where the semimembranous muscle attaches. It also attaches to the edge of the medial semilunar cartilage. The ligament is susceptible to strain at the joint line or avulsion at its origin or insertion.

Medial collateral ligament syndrome is characterized by medial joint pain that is made worse with flexion or external rotation of the knee.

SIGNS AND SYMPTOMS

Patients with injury of the medial collateral ligament will exhibit tenderness along the course of the ligament from the medial femoral condyle to its tibial insertion. If the ligament is avulsed from its bony insertions, tenderness may be localized to the proximal or distal ligaments, whereas patients suffering from strain of the ligament will exhibit more diffuse tenderness. Patients with severe injury to the ligament may exhibit laxity of the joint when valgus and varus stress are placed on the affected knee. Because pain may produce muscle guarding, magnetic resonance imaging (MRI) of the knee may be necessary to confirm the clinician’s clinical impression. Joint effusion and swelling may be present with injury to the medial collateral ligament but also are suggestive of intra-articular damage. Again, MRI will help confirm the diagnosis.

TREATMENT

Initial treatment of the pain and functional disability associated with injury to the medial collateral ligament should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Any repetitive activity that may exacerbate the patient’s symptomatology should be avoided. For patients who do not respond to these treatment modalities and do not have a lesion that will require surgical repair, the following injection technique may be a reasonable next step. Injection of the medial collateral ligament is carried out by placing the patient in the supine position with a rolled blanket underneath the knee to gently flex the joint. MRI should be carried out on all patients with injury to the medial collateral ligament who fails to respond to conservative therapy or who exhibit joint instability on clinical examination. The described injection technique is extremely effective in the treatment of pain secondary to the aforementioned causes of medial collateral ligament syndrome. Coexistent bursitis, tendinitis, arthritis, and internal derangement of the knee may also contribute to the patient’s pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.