Mechanism of Injury

Mechanism of Injury
This has already been described.
Types
Depending upon on the degree of tear collateral
ligament injuries are graded into three types.
Classification
(American Medical Association)
Sprain  Strain
(Ligament injury) (Muscle and tendon injuries)
I Degree II Degree (1/3-2/3) III Degree
• Minimal • More • Complete
tear (< 1/3) disruption disruption
instability
• Local tenderness • No instability
• No instability
+ If joint ++ If joint +++ If joint
separation separation separation
is < 5 mm is > 5-10 mm is > 10 mm..Investigations
• Stress radiographs at 15-20° of valgus.
• MRI helps to localize the MCL tears, ACL,
meniscal injuries, etc.
• Arthrograms and arthroscopy to evaluate and
rule out meniscal and cruciate pathology.
Treatment
Fresh injury nonoperative treatment is the mainstay
of treatment.
I° Sprain → symptomatic treatment, nonsteroidal
anti-inflammatory drugs (NSAIDs), etc.
II° Sprain → long leg cast for 4-6 weeks with knee
in 30-40° of flexion.
III° Sprain → surgical repair in isolated tears.
Repair and reconstruction in old tears or in
associated injuries . Brace is required
for 4-7 months.
Old Cases
Here surgery is the main stay of treatment and
consists of mainly reconstruction.
Tibial collateral ligament (TCL) injury: If TCL is intact
but lax, then distal transfer is done. If ligament is
destroyed, reconstruction using hamstrings or
semitendinosus is done.
Fibular collateral ligament injury: If adequate and thick,
distal transfer is recommended. If destroyed,
reconstruction using fascia lata, biceps tendon, etc.
is done.