MILD TO MODERATE MEDIAL COLLATERAL LIGAMENT (MCL) INJURIES OF THE KNEE: SONOGRAPHIC FINDINGS AND SONOGRAPHIC VALGUS STRESS TEST

2008 ◽  
Vol 11 (01) ◽  
pp. 9-14 ◽  
Author(s):  
Yeroham Kleinbaum ◽  
Alexander Blankstein
Keyword(s):  
Clinical Diagnosis ◽  
Medial Collateral Ligament ◽  
Stress Test ◽  
Joint Space Width ◽  
Joint Space ◽  
Average Thickness ◽  
Proper Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Space Width

The purposes of this study are to describe the sonographic findings of the injured medial collateral ligament (MCL) of the knee, to perform a sonographic valgus stress test, and to correlate these findings in order to advance the proper treatment for these patients. We examined 23 patients with clinical diagnosis of MCL injury. We evaluated proximal and distal MCL thickness, free fluid, and avulsion fractures. In addition, we performed a sonographic valgus stress test in the stress and rest positions. We also examined the knee joint on the same side in 18 sex- and age-matched patients with no history of knee injury as a control. The average thickness of proximal MCL was 6.4 mm (range, 4.2–8.1 mm) in injured MCL and 4.3 mm (range, 3.2–6.2 mm) in normal MCL. The average thickness of distal MCL was 4.4 mm (range, 2.4–6.1 mm) in injured MCL and 3.1 mm (range, 2.1–4.1 mm) in normal MCL. The average joint space width of the injured knee at rest was 6.1 mm (range, 4.0–8.5 mm) and increased to 10.5 mm (range, 7.6–14.0 mm) after stress. The average joint space width of the normal knee at rest was 6.7 mm (range, 5.0–7.7 mm) and increased to 9.6 mm (range, 7.7–10.4 mm) after stress. In conclusion, the combination of the sonographic findings in MCL injury and the real-time sonography valgus stress test can support the clinical diagnosis and pinpoint the exact location of isolated MCL injury, thus advancing the proper treatment of the patient.

Medial Elbow Joint Laxity in Professional Baseball Pitchers

1998 ◽  
Vol 26 (3) ◽  
pp. 420-424 ◽  
Author(s):  
Todd S. Ellenbecker ◽  
Angelo J. Mattalino ◽  
Erik A. Elam ◽  
Roger A. Caplinger
Keyword(s):  
Elbow Joint ◽  
Joint Space Width ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Professional Baseball ◽  
Stress Radiography ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Baseball Pitchers ◽  
Space Width

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 0.97 mm, while the nondominant elbow opened 0.88 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

scholarly journals Evaluation of the clinical examination in thediagnosis of acute medial collateral ligament injury of the knee joint in comparism with examination under general anesthesia

2018 ◽  
Vol 14 (1) ◽  
pp. 37-41
Author(s):  
Laith Saleem Sabri
Keyword(s):  
General Anesthesia ◽  
Clinical Examination ◽  
Medial Collateral Ligament ◽  
Stress Test ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Knee Ligaments ◽  
Medial Collateral Ligament Injury ◽  
Grade Ii

Background: Tear of MCL of the knee is a frequent problem among knee ligaments injuries.Injuries to the MCL are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. Contrary to most other knee ligaments the medial collateral ligament (MCL) has an excellent ability to heal, being fairly large and well vascularised structure. The vast majority of isolated medial ligament injuries heal without significant long-term problems Objectives: is to compare between the early clinical examination, and assessment under general anesthesia (GA), and to find out the best methods to assess the MCL tear especially in suspected cases. Type of the study:Cross- sectional study. Methods: Fifty patients are collected from casualty & outpatient units from November/2014 to October/2016 with MCL injury  in AL-Kindy teaching hospital.We decided to evaluate them under general anesthesia by valgus stress test at 30 degrees & 0 degrees to estimate the integrity of MCL, in addition to    anterior &posterior Drawer test to evaluate anterior &posterior cruciate ligaments Results: :  From the 50 patients we select, there were 21 patients seen in the examination to have MCL tear.1 of them were    Grade I ( 4.8% ),14 of them were Grade II (66.7% ),&6 of them were Grade III (28.5%)Associated injuries  with ACL injury  were 5 patients, with  PCL injury    were 1 patient and with medial capsular injury were 2 patients.  Follow up of case range from (2-10) weeks with an average of 6 weeks combined with physiotherapy programs. Conclusions: Diagnosis of MCL tear by valgus stress test under GA  is the best method for the assessment of MCL tear in suspected cases.

scholarly journals Tibial Avulsion with Intra-Articular Entrapment of Medial Collateral Ligament with Posterior Cruciate Ligament Tear with Posterior Root Medial Meniscus Tear: A Case Report of an Unusual Injury Triad

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ishan Shevate ◽  
Girish Nathani ◽  
Ashwin Deshmukh ◽  
Anirudh Kandari
Keyword(s):  
Case Report ◽  
Medial Collateral Ligament ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Stress Test ◽  
Joint Line ◽  
Posterior Root ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Medial Knee

Introduction: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint; however, its displacement into the medial knee compartment is rare. Traumatic posterior root of medial meniscus (PRMM) tears are commonly found in high-grade injuries involving anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) tears along with MCL tears. Diagnosis of these injuries can be made by a preoperative magnetic resonance imaging (MRI), but they can be missed at times due to severe soft-tissue swelling in the acute phase. Case Report: A 25-year-old gentleman presented with injury to the front of his left knee 5 days back. On examination, he had a Grade 3 effusion with valgus stress test and posterior drawer test being positive and medial joint line tenderness was present. A firm localized swelling was palpable on the medial joint line. MRI scan revealed a mid-substance PCL tear, ACL sprain, PRMM tear, and tibial side rupture of superficial MCL with proximally migrated wavy MCL fibers lying below the medial meniscus confirmed on arthroscopy. Medial meniscus root repair by pull through technique and PCL reconstruction with a 3-strand peroneus longus graft followed by open MCL repair with augmentation using a semitendinosus graft was performed. Postoperatively, the knee was kept in a straight knee brace for 4 weeks, followed by a hinged knee brace and appropriate physiotherapy were started. At 2 years follow-up, the patient had attained full range of knee motion with good quadriceps strength, tibial step off maintained, and negative posterior drawer test and valgus stress test. Displacement of torn MCL into the medial knee compartment is an extremely rare injury. Proximal or distal avulsion of MCL with intra-articular incarceration has been reported in isolation or associated with ACL tear. Such an injury triad as reported here has not been reported in the literature to the best of our review. Conclusion: In our case, we report a ver

scholarly journals Is it possible to use stress radiographs as a tool to diagnose medial meniscus posterior root tears?

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0007
Author(s):  
Ali Engin Daştan ◽  
Elcil Kaya Biçer ◽  
Hüseyin Kaya ◽  
Emin Taşkıran
Keyword(s):  
Medial Meniscus ◽  
Weight Bearing ◽  
Joint Space Width ◽  
Joint Space ◽  
X Rays ◽  
Meniscal Extrusion ◽  
Valgus Stress ◽  
Varus Stress ◽  
The Difference ◽  
Space Width

Aim: Medial meniscus posterior root tear (MMPRT) causes meniscal extrusion, loss of meniscus function, arthritic changes. Clinical history, physical examination and magnetic resonance imaging (MRI) findings are useful for the diagnosis of MMPRT. The aim of this study is to evaluate the utility of stress X-rays in the diagnosis of MMPRT. Methods: Twenty patients who had undergone high tibial osteotomy between March 2015 and May 2016 and whose preoperative bilateral varus and valgus stress x-rays (Telos device) along with weight bearing x-rays were available were included. These patients were grouped into two according to integrity of posterior roots of their medial menisci; there were ten patients both in the study and control groups. Lateral joint space width (LJW) on varus stress x-rays, medial joint space width (MJW) on valgus stress x-rays as well as LJW and MJW on weight bearing x-rays were measured bilaterally. Intragroup comparisons of joint space widths between index and opposite knees were performed. Differences of MJW and LJW between index and opposite knees were calculated. Differences of joint space widths between stress x-rays and weight bearing x-rays were also calculated. The changes in joint space widths between the two groups were compared. Statistical analyses were performed utilizing SPSS 18.0. Significance level was set at 0.05. Results: In MMPRT group, opening of LJ space of index knees under varus stress was greater than that of opposite knees (Index: (mean±SD) 10,27±1,17 mm, opposite: 8,61±1,37 mm; p<0,0001). In the control group the difference was not significant (Index: 9,29±2,55 mm, opposite: 9,68±1,44 mm; p=0,566). The difference in the opening of LJW (under varus stress) between index and opposite knees was significantly greater in the study group (p=0,013). The difference between LJW under weight-bearing and varus stress conditions was significantly greater in the study group. (Study: 3,64±0.217 mm, control:2,28±0,182 mm, p=0.018). Conclusions: The findings of this study showed that in patients who had MMPRTs, an increased opening in the LJW was observed under varus stress conditions. This may be relevant with the fact that when varus stress is applied, meniscal extrusion is increased in case of a MMPRT. Stress x-rays could be a useful tool in the diagnosis of MMPRTs. Further studies are needed to determine the sensitivity and specificity of this diagnostic tool.

The “Moving Valgus Stress Test” for Medial Collateral Ligament Tears of the Elbow

2005 ◽  
Vol 33 (2) ◽  
pp. 231-239 ◽  
Author(s):  
Shawn W. M. O'Driscoll ◽  
Richard L. Lawton ◽  
Adam M. Smith
Keyword(s):  
Physical Examination ◽  
Medial Collateral Ligament ◽  
Imaging Techniques ◽  
Stress Test ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Elbow Pain ◽  
Examination Technique ◽  
Highly Sensitive ◽  
The Mean

Background The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. Hypothesis The “moving valgus stress test” is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 ° and 70 °. Results The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 ° to 70 °. The mean angle at which pain was at a maximum was 90 ° of elbow flexion. Conclusions The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

The lateral joint space width can be measured reliably with Telos valgus stress radiography in medial knee osteoarthritis

2018 ◽  
Vol 48 (7) ◽  
pp. 1069-1077 ◽  
Author(s):  
Daan Koppens ◽  
Ole Gade Sørensen ◽  
Stig Munk ◽  
Søren Rytter ◽  
Solveig Kärk Abildtrup Larsen ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Joint Space Width ◽  
Joint Space ◽  
Stress Radiography ◽  
Valgus Stress ◽  
Medial Knee ◽  
Medial Knee Osteoarthritis ◽  
Space Width

Quantitative Evaluation of Joint Space Width in the Lateral Compartment after Medial Unicompartmental Knee Arthroplasty: Comparison of Three Radiographic Views

2017 ◽  
Vol 31 (08) ◽  
pp. 730-735
Author(s):  
Ju'an Yue ◽  
Wanshou Guo ◽  
Fuyin Wan ◽  
Pengfei Wen ◽  
Zhaohui Liu ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Joint Space Width ◽  
Lateral Compartment ◽  
Joint Space ◽  
Valgus Stress ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Group A ◽  
Group B ◽  
Space Width

AbstractLateral compartment cartilage deterioration is the most common complication affecting medial unicompartmental knee arthroplasty (UKA) survivorship. The purpose of this study was to determine the best method of judging the degeneration of cartilage in the lateral compartment after medial UKA through analysis of different radiographic views. Forty-two participants were divided into two groups. Patients in Group A were followed for at least 10 months after undergoing a medial UKA (mean: 17.67 ± 7.65 months, range: 10–24 months), whereas those in Group B were evaluated 3 days after surgery. Joint space width in the lateral compartment of all patients was evaluated using three types of knee radiographs: weight-bearing anterior posterior (AP), supine AP, and supine valgus stress. No difference in joint space width in the lateral compartment after medial UKA was found for the three kinds of radiographs in Group A (F = 0.97, p = 0.39) and Group B (F = 1.499, p = 0.233). After evaluating the patients 3 days after surgery or following them for approximately 18 months after medial UKA, we determined that weight-bearing AP, supine AP, and supine valgus stress knee radiographs were comparable when used to assess residual cartilage thickness of the lateral compartment.

The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study

2019 ◽  
Vol 47 (12) ◽  
pp. 2827-2835
Author(s):  
Ranita H.K. Manocha ◽  
James A. Johnson ◽  
Graham J.W. King
Keyword(s):  
Medial Collateral Ligament ◽  
Muscle Activation ◽  
Mechanical Stability ◽  
Biomechanical Study ◽  
Return To Play ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Active Motion ◽  
Early Return

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

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