MANUAL MINORS
A collateral ligament tear affects one of the ligaments located on the sides of the knee, with the medial collateral ligament (MCL) being the most commonly injured. This injury typically occurs due to direct trauma to the outer side of the knee, causing excessive strain on the medial ligament. Patients usually present with pain on the inner side of the knee, instability, and difficulty walking.
Diagnosis
Diagnosis is made through patient history and physical examination of the knee. Stress testing in valgus for the medial collateral ligament and in varus for the lateral collateral ligament helps determine the location and severity of the injury. Magnetic resonance imaging (MRI) can confirm the extent of the tear and rule out associated injuries, such as meniscal or cruciate ligament tears.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Anterior Cruciate Ligament Tear | Rotational instability, positive Lachman’s sign. |
Meniscal Injury | Knee locking, joint line pain. |
Simple Ligament Sprain | Pain without significant instability, less sensitivity in stress tests. |
Patellar Tendinitis | Localised pain in the front of the knee, without instability. |
Anserine Bursitis | Localised pain at the insertion of the pes anserinus tendon, more distal. |
Emergency Management
Initial management includes immobilisation of the knee with a splint or functional brace, application of ice to reduce swelling, and administration of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.
The patient should avoid weight-bearing on the affected leg until a more detailed evaluation can be performed. In severe cases, referral to an orthopaedic specialist is recommended.
Definitive Treatment
Treatment depends on the severity of the injury. Partial tears are typically managed conservatively with physiotherapy, muscle strengthening, and the use of a functional knee brace. For complete tears or cases of significant instability, reconstructive surgery may be required, especially in young patients or athletes. Post-surgical rehabilitation is essential for full recovery.
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