Database: MEDLINE <1966 to May Week 4 2002>
Search Strategy: (Medial collateral ligament injuries)
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exp Knee Injuries/ (8213)
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exp COLLATERAL LIGAMENTS/in [Injuries] (426)
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1 and 2 (120)
4
limit 3 to (human and english language) (97)
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limit 4 to yr=1996-2002 (68)
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medial.tw. and 5 (32)
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from 6 keep 1-32 (32)
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from 7 keep 1-32 (32)
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<1>
Unique Identifier
9059420
Medline Identifier
97212564
Authors
Lundberg M. Thuomas KA. Messner K.
Institution
Department of Orthopaedics and Sports Medicine, University Hospital,
Linkoping, Sweden.
Title
Evaluation of knee-joint cartilage and menisci ten years after isolated
and combined ruptures of the medial collateral ligament. Investigation by
weight-bearing radiography, MR imaging and analysis of proteoglycan
fragments in the joint fluid.
Source
Acta Radiologica. 38(1):151-7, 1997 Jan.
Abstract
PURPOSE: To compare radiography, MR imaging, and chemical analysis in
posttraumatic knees. MATERIAL AND METHODS: Ten matched pairs with either
isolated partial rupture of the medial collateral ligament or combined
medial collateral ligament/anterior cruciate ligament rupture were
compared with matched controls 10 years after trauma. Weight-bearing
radiographs and MR examinations were compared with proteoglycan fragment
concentrations in the joint fluid. RESULTS: The chemical analyses were
similar in both trauma groups. The radiographs showed mild signs of
arthrosis in half the patients with combined injury. MR images showed
almost all injured knees to have degenerative changes of various degrees
in the cartilage and menisci. More frequent and more advanced changes
were found after combined injury than after isolated injury (p < 0.01).
There were no changes in the controls. CONCLUSION: MR imaging is the best
method for detecting and differentiating early posttraumatic knee
arthrosis.
<2>
Unique Identifier
9762977
Medline Identifier
98433941
Authors
De Maeseneer M. Lenchik L. Starok M. Pedowitz R. Trudell D.
Resnick D.
Institution
Department of Radiology, Veterans Administration Medical Center, San
Diego, CA 92161, USA.
Title
Normal and abnormal medial meniscocapsular structures: MR imaging and
sonography in cadavers.
Source
AJR. American Journal of Roentgenology. 171(4):969-76, 1998 Oct.
Abstract
OBJECTIVE: The purpose of this study was to develop imaging criteria
for the diagnosis of meniscocapsular separation by correlating findings
on MR imaging, MR arthrography, and sonography of normal and abnormal
medial meniscocapsular structures with corresponding anatomic sections in
cadavers. MATERIALS AND METHODS: Eight cadaveric knee specimens were
examined with MR imaging, MR arthrography, and sonography before
arthroscopy. In six specimens the following lesions were arthroscopically
created: meniscocapsular separation (n = 3), medial collateral ligament
(MCL) tear (n = 3), tear of the meniscofemoral extension of the deep MCL
(n = 2), and coronary ligament tear (n = 2). After arthroscopy, all
imaging studies were repeated. The specimens were sectioned for
correlation with imaging studies. RESULTS: MR findings that correlated
with meniscocapsular separation were interposition of fluid between the
meniscus and the MCL, irregular meniscal outline, and increased distance
between the meniscus and the MCL. On MR arthrography meniscocapsular
separation correlated with interposition of contrast medium between the
meniscus and the MCL. Tears of the meniscofemoral extension of the deep
MCL were best shown on MR arthrography. Sonography showed deep and
superficial MCL lesions but did not show meniscocapsular separations.
CONCLUSION: In arthroscopically created meniscocapsular separation, the
lesion is suggested on MR images when fluid is interposed between the
meniscus and the MCL, when the meniscal outline is irregular, or when the
distance between the meniscus and the MCL is increased. On MR
arthrograms, a meniscocapsular separation is suggested when contrast
medium is interposed between the meniscus and the MCL. Sonography does
not allow accurate diagnosis of meniscocapsular separation.
<3>
Unique Identifier
9574586
Medline Identifier
98233773
Authors
Rubin DA. Kettering JM. Towers JD. Britton CA.
Institution
Department of Radiology, University of Pittsburgh Medical Center, PA
15213, USA.
Title
MR imaging of knees having isolated and combined ligament injuries.
[see comments.].
Comments
Comment in: AJR Am J Roentgenol. 1999 Jan;172(1):239-40 ; 9888775
Source
AJR. American Journal of Roentgenology. 170(5):1207-13, 1998 May.
Abstract
OBJECTIVE: Although clinical evaluation and MR imaging both accurately
reveal injuries in knees with isolated ligament tears, physical
examination becomes progressively less reliable when multiple lesions
exist. We investigated the accuracy of MR imaging of knees having varying
degrees and numbers of ligament injuries. SUBJECTS AND METHODS: We
prospectively interpreted the MR images of 340 consecutive injured knees
and compared these interpretations with the results of subsequent
arthroscopy or open surgery, which served as the gold standard. Our
interpretations of MR images focused on five soft-tissue supporting
structures (the two cruciate ligaments, the two collateral ligaments, and
the patellar tendon) and the two menisci. Patients were divided into
three groups: no ligament injuries, single ligament injuries, and
multiple ligament injuries. RESULTS: Using MR imaging, we found overall
sensitivity and specificity for diagnosing ligament tears to be 94% and
99%, respectively, when no or one ligament was torn and 88% and 84%,
respectively, when two or more supporting structures were torn. The
difference in specificity was statistically significant (p < .0001).
Sensitivity for diagnosing meniscal tears decreased as the number of
injured structures increased, but the relationship achieved statistical
significance (p = .001) only for the medial meniscus. For all categories
of injury, MR imaging was more accurate than clinical evaluation,
statistics for which were taken from the orthopedic literature.
CONCLUSION: In knees with multiple ligament injuries, the diagnostic
specificity of MR imaging for ligament tears decreases, as does the
sensitivity for medial meniscal tears.
<4>
Unique Identifier
10626911
Medline Identifier
20090337
Authors
Shelbourne KD. Jennings RW. Vahey TN.
Institution
Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
Title
Magnetic resonance imaging of posterior cruciate ligament injuries:
assessment of healing.
Source
American Journal of Knee Surgery. 12(4):209-13, 1999 Fall.
Abstract
This study evaluated posterior cruciate ligament (PCL) healing using
magnetic resonance imaging (MRI). Forty knees with acute PCL injuries
underwent acute and follow-up (>6 months) MRI examinations. Twenty-three
knees had isolated injuries, and 17 knees had associated ligament damage.
The initial MRI scans showed 22 high-grade injuries with complete
disruption, 14 with midgrade injuries with extensive edema on T2 images
with some bridging fibers present, and 4 patients had low-grade injuries.
At a mean time of 3.21.3 years after the initial MRI, the follow-up MRIs
revealed the PCL healed with continuity in all of the low-grade and midgrade injuries, and in 19 of 22 high-grade injuries. Of the 19 high-grade
PCL tears that healed, 4 healed with normal contour and 15 were
continuous with altered morphology at follow-up. Of 11 high-grade PCLinjured knees with associated ligament damage, only 1 PCL failed to
regain continuity. The 3 PCLs that did not regain continuity were in 2
patients with isolated injuries and 1 patient with associated anterior
cruciate and medial collateral ligament injuries. These results
demonstrate that most nonoperatively treated PCL injuries, even in
association with other knee ligament damage, can heal with continuity.
<5>
Unique Identifier
9006689
Medline Identifier
97159349
Authors
Hull ML.
Institution
Department of Mechanical and Aeronautical Engineering, University of
California, Davis 95616-5294, USA.
Title
Analysis of skiing accidents involving combined injuries to the medial
collateral and anterior cruciate ligaments.
Source
American Journal of Sports Medicine. 25(1):35-40, 1997 Jan-Feb.
Abstract
Two types of ligament injuries common in skiing are the isolated
ruptures of the anterior cruciate and ruptures of the medial collateral,
either with or without rupture of the anterior cruciate. Based on
research related to ligament injury mechanics and two-mode release
binding function, the purpose of this paper was to critically assess the
ability of two-mode release bindings to prevent combined medial
collateral and anterior cruciate ligament injuries. Making this
assessment entailed several steps. First, I determined the loads
typically transmitted by the knee during falls in which combined injuries
occurred. Because more than one load was transmitted, the next step was
to discern which of the loads was more damaging. Finally, heel-toe type
bindings were evaluated for their potential to release in response to
damaging loads. I concluded that combined medial collateral and anterior
cruciate ligament injuries typically occur in forward, twisting-type
falls in which the primary loads are external axial and valgus moments.
An external axial moment is more damaging than a valgus moment, both to
the medial collateral ligament when the joint is intact and to the
anterior cruciate ligament when the medial collateral ligament is
damaged. Because heel-toe type bindings offer release sensitivity to this
moment, the release level of the toepiece in twist is an important factor
in the prevention of these injuries.
<6>
Unique Identifier
9167817
Medline Identifier
97310918
Authors
Levy AS. Wetzler MJ. Lewars M. Laughlin W.
Institution
American Orthopaedic Rugby Football Association, Philadelphia,
Pennsylvania, USA.
Title
Knee injuries in women collegiate rugby players.
Source
American Journal of Sports Medicine. 25(3):360-2, 1997 May-Jun.
Abstract
We evaluated the prevalence and patterns of knee injuries in 810 women
collegiate rugby players. Injuries that resulted in players missing at
least one game were recorded and a questionnaire was used to delineate
players' rugby and knee injury history. There were 76 total knee injuries
in 58,296 exposures. This resulted in a 1.3 knee injury rate per 1000
exposures. Twenty-one anterior cruciate ligament tears were reported for
a 0.36 incidence per 1000 exposures. Other injuries included meniscal
tears (25), medical collateral ligament sprains (23), patellar
dislocations (5), and posterior cruciate ligament tears (2). Sixty-one
percent of the medial collateral ligament sprains occurred in rugby
forwards and 67% of anterior cruciate ligament tears occurred in rugby
backs. All other injuries occurred with equal frequency in backs and
forwards. This study demonstrates that knee injury rates in women's
collegiate rugby are similar to those reported for other women's
collegiate sports. The overall rate of anterior cruciate ligament injury
in women's rugby, however, is slightly higher than that reported for
women soccer and basketball players.
<7>
Unique Identifier
9474396
Medline Identifier
98134737
Authors
Miller MD. Osborne JR. Gordon WT. Hinkin DT. Brinker MR.
Institution
United States Air Force Academy Hospital, Colorado, USA.
Title
The natural history of bone bruises. A prospective study of magnetic
resonance imaging-detected trabecular microfractures in patients with
isolated medial collateral ligament injuries.
Source
American Journal of Sports Medicine. 26(1):15-9, 1998 Jan-Feb.
Abstract
We conducted a prospective study to evaluate bone bruises, or
trabecular microfractures, associated with isolated medial collateral
ligament injuries. Magnetic resonance imaging was performed on 65
patients with isolated medial collateral ligament injuries determined by
physical examination and imaging studies. Of these 65 patients, 29 (45%)
had associated trabecular microfractures. Follow-up images were completed
at various intervals on 24 of these 29 patients (83%). Complete
resolution of these lesions was observed in all cases. This process
appears to occur as a result of gradual diffusion over a period of 2 to 4
months. Bone bruises associated with medial collateral ligament injuries
are approximately one-half as common as bone bruises associated with
anterior cruciate ligament injuries. However, medial collateral ligamentassociated trabecular microfractures may be a better natural history
model because these injuries are treated nonoperatively.
<8>
Unique Identifier
8775113
Medline Identifier
96371278
Authors
Lundberg M. Messner K.
Institution
Department of Orthopaedics-Sports Medicine, University Hospital,
Linkoping, Sweden.
Title
Long-term prognosis of isolated partial medial collateral ligament
ruptures. A ten-year clinical and radiographic evaluation of a
prospectively observed group of patients.
Source
American Journal of Sports Medicine. 24(2):160-3, 1996 Mar-Apr.
Abstract
We prospectively observed 38 patients with nonoperatively treated
isolated partial ruptures of the knee medial collateral ligament at 3
months, 4 years, and 10 years after the initial trauma using clinical and
radiographic examinations. The initial diagnoses were based on clinical
and arthroscopic examinations. Three months after injury, 28 patients
(74%) had regained nearly normal knee function and muscle strength, and
75% of these patients could perform at their preinjury activity level
(competitive team sports). Five patients (13%) had increased valgus
laxity (grade 1) in the injured knee. After 4 years, the patients had a
median Lysholm score of 100 (range, 64 to 100). Thirty-three patients
(87%) had normal knee function during strenuous activities. Repeat
injuries to the medial collateral ligament occurred in two patients (5%),
and another two patients sustained cruciate ligament injuries during the
follow-up period. After 10 years, the Lysholm score (median, 95; range,
73 to 100) was lower compared with the 4-year score (P < 0.03), but the
patients still performed on a similarly high activity level. Five
patients (13%) had distinct signs of beginning osteoarthritis (Fairbank's
signs) on radiographs, but none had joint space reduction.
<9>
Unique Identifier
10496578
Medline Identifier
99424897
Authors
Nordt WE 3rd. Lotfi P.
Institution
Plotkin E.
Williamson B.
West End Orthopaedic Clinic, Richmond, Virginia 23229, USA.
Title
The in vivo assessment of tibial motion in the transverse plane in
anterior cruciate ligament-reconstructed knees.
Source
American Journal of Sports Medicine. 27(5):611-6, 1999 Sep-Oct.
Abstract
Twenty-one knees with acutely injured anterior cruciate ligaments were
reconstructed with patellar tendon autografts. Eight of the knees had
concomitant medial ligament injuries that were not addressed surgically.
Follow-up evaluation (average, 25 months) included computed tomography
measurements to analyze transverse-plane laxity in both translation and
rotation. These measurements were performed with the patient's leg in a
load cell device that stabilizes the distal femur and applies known
anterior translational force to the proximal tibia at approximately 20
degrees of flexion. A torque apparatus was used to apply internal and
external rotational torque to the leg. Images of the tibial plateau in
neutral, internal, and external rotation were performed, with and without
an anterior translational force. Both knees of each patient were tested
and categorized as group I (anterior cruciate ligament-reconstructed) or
group II (uninjured). Translation as measured by computed tomography
averaged 1 mm side-to-side difference. Internal rotation averaged 8.7
degrees in group I knees and 10.8 degrees in group II knees. External
rotation averaged 9.1 degrees in group I knees and 7.4 degrees in group
II knees. The eight knees with concomitant medial ligament injuries were
analyzed separately; external rotation without anterior load in group I
was 9.5 degrees, compared with 5 degrees in group II. This difference was
significant (P < 0.01).
<10>
Unique Identifier
9143665
Medline Identifier
97288714
Authors
McDougall JJ. Bray RC. Sharkey KA.
Institution
Department of Surgery, University of Calgary, Alberta, Canada.
Title
Morphological and immunohistochemical examination of nerves in normal
and injured collateral ligaments of rat, rabbit, and human knee joints.
Source
Anatomical Record. 248(1):29-39, 1997 May.
Abstract
BACKGROUND: Knee joints possess an abundant nerve supply that relays
sensory and motor information on such aspects as proprioception,
nociception, and vasoregulation. Although synovial innervation has been
well documented, little is known of the nerves that supply the collateral
ligaments. METHODS: The morphology of rabbit and human collateral
ligament nerves was examined by silver impregnation. Immunohistochemistry
was performed on rabbit and rat collateral ligaments to determine the
presence of peptidergic nerves in these tissues. A 6-week gap injury was
performed on three rabbit medial collateral ligaments, and the
localisation of peptidergic nerves in these tissues was determined.
RESULTS: Irrespective of species or type of ligament examined, the
greatest density of nerve fibres was found in the epiligament. Nerve
fibres commonly accompanied blood vessels along the long axis of the
ligament and then entered the substance of the tissue before ramifying in
the deeper layers. Substance P and calcitonin gene-related peptideimmunoreactive nerve fibres were found in the collateral ligaments of the
rat and rabbit. Injured ligaments showed a higher than normal level of
immunoreactivity in and around the healing zone; however, the nerve
fibres appeared tangled and truncated. CONCLUSIONS: Like other structures
in knee joints, collateral ligaments possess a complex nerve supply. The
presence of peptidergic nerves suggests that ligaments may be susceptible
to neurogenic inflammation and may be centres of articular nociception.
<11>
Unique Identifier
10447618
Medline Identifier
99376645
Authors
Petersen W. Laprell H.
Institution
Lubinusklinik, Hospital for Surgery and Orthopedics, Steenbeker Weg 25,
D-24106 Kiel, Germany.
Title
Combined injuries of the medial collateral ligament and the anterior
cruciate ligament.Early ACL reconstruction versus late ACL
reconstruction.
Source
Archives of Orthopaedic & Trauma Surgery. 119(5-6):258-62, 1999.
Abstract
Aim of this retrospective study is to evaluate the effect of acute and
late anterior cruciate ligament (ACL) reconstruction in patients with a
combined injury of the ACL and the medial collateral ligament (MCL). All
MCL injuries were treated non-operatively. In 27 patients (group I) we
performed early ACL reconstruction (within the first 3 weeks after
injury). The postoperative rehabilitation protocol included brace
treatment for all patients over a period of 6 weeks. In 37 patients we
performed late ACL reconstruction (after a minimum of 10 weeks). In this
group initial non-operative MCL treatment (6 weeks brace treatment) was
followed by a period of accelerated rehabilitation. Patients with late
ACL reconstruction had a lower rate of loss of motion after finishing the
postoperative rehabilitation programme and a lower rate of rearthroscopies for a loss of extension (group I: 4 patients, group II: 1
patient). The difference in the mean quadriceps muscle strength (group I:
83.3%, group II: 86.3%) was not statistically significant. After a mean
interval of 22 months, we saw no difference in the frequency of anterior
or medial instabilities or in the loss of motion. The Lysholm score was
significantly better in the group with late ACL reconstruction (group I:
85.3, group II: 89.9). The position on the Tegner activity scale
decreased in both groups, to 5.5 in group I (preoperatively: 6.0) and to
5.6 in group II (preoperatively: 5.9). With regard to the lower rate of
motion complications in the early postoperative period, the lower rate of
re-arthroscopies, and the significantly better results in the Lysholm
score, we prefer late ACL reconstruction in the treatment of combined
injuries of the ACL and the MCL.
<12>
Unique Identifier
9685095
Medline Identifier
98348237
Authors
Zuhosky JP. Dugan SA. Young JL. Bode RK. Kelly JP.
Institution
Department of Physical Medicine and Rehabilitation, Northwestern
University Medical School, Chicago, IL, USA.
Title
A retrospective review of the incidence and rehabilitation outcome of
concomitant traumatic brain injury and ligamentous knee injury.
Source
Archives of Physical Medicine & Rehabilitation. 79(7):805-10, 1998
Jul.
Abstract
OBJECTIVES: To estimate the incidence of ligamentous knee injuries in
patients with traumatic brain injury (TBI) involved in pedestrian versus
motor vehicle collisions (PVMVC), to identify associated risk factors,
and to compare rehabilitation outcomes and costs in TBI patients with and
without ligamentous knee injury. DESIGN: Retrospective, case control.
SETTING: An academic rehabilitation hospital with a large metropolitan
referral base. PATIENTS: Twenty-three consecutive adolescent and adult
subjects admitted for acute inpatient rehabilitation after a PVMVC from
January 1, 1994, to January 1, 1996. RESULTS: Five subjects (22%) were
found to have a ligamentous knee injury, one with bilateral injuries. Two
of these six injuries were diagnosed only after presentation to the
rehabilitation setting. The most common injury was an anterior cruciate
ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial
collateral ligament injury was identified in 4 of 6 injured knees. The
risk of ligamentous knee injury was most closely associated with the
presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001).
There was no statistical difference between groups with and without
ligamentous knee injuries with respect to age, gender, inpatient acute or
rehabilitation length of stay, admission, discharge, or change in motor
Functional Independence Measure (FIM) interval measures, or
rehabilitation costs. Four of the 5 patients with ligamentous knee
injuries were successfully managed nonoperatively. A case illustrating
longitudinal management is presented. CONCLUSIONS: TBI and ligamentous
knee injuries, in particular ACL injuries, are common comorbidities after
PVMVC. Physicians must maintain a high index of suspicion for ligamentous
knee injuries in this population, particularly when a tibial plateau
fracture is present. TBI patients with and without ligamentous knee
injuries can have comparable functional outcomes when the ligament
injuries are identified and appropriately managed, without incurring
undue cost or length of inpatient rehabilitation.
<13>
Unique Identifier
11337708
Medline Identifier
21234782
Authors
Ambrose HC. Simonian PT. Sims WF.
Institution
Department of Orthopaedic Surgery, The University of Washington,
Seattle, Washington 98195, U.S.A.
Title
Arthroscopic localization of medial collateral ligament injury: Report
of 2 cases in adults.
Source
Arthroscopy. 17(5):E21, 2001 May.
Abstract
Injury to the medial collateral ligament has previously been assessed
primarily using the clinical examination and magnetic resonance imaging.
In this article, we describe an adjunct to these diagnostic tools: an
arthroscopic observation to assess the specific location of the medial
collateral ligament injury.
<14>
Unique Identifier
11951187
Medline Identifier
21947530
Authors
Borden PS. Kantaras AT. Caborn DN.
Institution
Division of Sports Medicine, The University of Louisville, Louisville,
Kentucky 40202, USA.
Title
Medial collateral ligament reconstruction with allograft using a
double-bundle technique.
Source
Arthroscopy. 18(4):E19, 2002 Apr.
Abstract
Medial collateral ligament (MCL) reconstruction has been a topic of
controversy in regard to the need for surgical reconstruction as well as
the type of surgical reconstruction to be performed. Combined anterior
cruciate ligament (ACL) and MCL reconstruction has been found to be
associated with a higher incidence of postoperative arthrofibrosis than
isolated ACL reconstruction; performing these reconstructions in a staged
format has been proposed to avoid this devastating complication. We
present a technique for MCL reconstruction that physiometrically reestablishes both anterior and posterior stabilizing components of the MCL
and is performed with a limited soft-tissue dissection. This technique
can easily be combined with an ACL allograft or hamstring reconstruction
without need for staged or significantly delayed procedure. The technical
details of this technique allow for stable fixation of an allograft
reconstruction to allow for immediate postoperative knee range of motion
with low patient morbidity because of the limited surgical approach.
<15>
Unique Identifier
9043600
Medline Identifier
97196510
Authors
Maffulli N. Chan KM. Bundoc RC. Cheng JC.
Institution
Department of Orthopaedics and Traumatology, Chinese University of Hong
Kong, Faculty of Medicine, Prince of Wales Hospital, Shatin, New
Territories, Hong Kong.
Title
Knee arthroscopy in Chinese children and adolescents: an eight-year
prospective study.
Source
Arthroscopy. 13(1):18-23, 1997 Feb.
Abstract
In the period January 1985 to December 1992, 69 Chinese boys and 20
Chinese girls (average 14.6 years, age range 6 to 16 years) with a total
of 92 involved knees underwent examination under anaesthesia and knee
arthroscopy. Two thirds of the patients were engaged in sports
activities. A haemarthrosis was present in 51 patients. In one patient,
Staphylococcus aureus was shown, and in two children a serous-purulent
aspirate grew Mycobacterium tuberculosis. The lateral meniscus was torn
in four knees and the medial meniscus in six. An intact discoid lateral
meniscus was found in five girls. Three partial anterior cruciate
ligament (ACL) tears, three complete ACL tears and two posterior cruciate
ligament tears were diagnosed. One child had an osteochondral defect of
the lateral femoral condyle accompanying an ACL and a lateral meniscal
tear. Nonspecific synovitis of unknown etiology was diagnosed in six
patients who had presented subacutely with at least a 2-month history of
a symptomatic monoarticular knee effusion with low grade local
inflammation and no history of major trauma. The synovitis gradually
resolved over a 6- to 10-month period after arthroscopy. Knee arthroscopy
in children and adolescent patients is safe, gives a high diagnostic
accuracy, and allows treatment of a variety of intraarticular conditions.
This study also demonstrates that the range of intraarticular knee
problems found in Chinese children and adolescents differs from that
described in their Western counterparts.
<16>
Unique Identifier
9343655
Medline Identifier
98003550
Authors
MacDonald PB.
Institution
Section of Orthopaedics, University of Manitoba, St Boniface General
Hospital, Winnipeg, Canada.
Title
Combined tear of the posterior cruciate and medial collateral ligaments
resulting in a locked knee.
Source
Arthroscopy. 13(5):639-40, 1997 Oct.
Abstract
A case is presented of a combined tear of the posterior cruciate and
medial collateral ligaments with medial collateral ligament fibers
herniated through the medial capsule and occupying the medial
compartment, which resulting in a locked knee. The author is not aware of
any reports in the literature of this and presents this to raise
awareness of another cause of knee locking.
<17>
Unique Identifier
10695848
Medline Identifier
20158395
Authors
Munshi M. Davidson M. MacDonald PB. Froese W. Sutherland K.
Institution
Department of Radiology, St. Boniface Hospital, University of Manitoba,
Winnipeg, Canada.
Title
The efficacy of magnetic resonance imaging in acute knee injuries.
Source
Clinical Journal of Sport Medicine. 10(1):34-9, 2000 Jan.
Abstract
OBJECTIVE: To evaluate the clinical efficacy of magnetic resonance
imaging (MRI) of the knee in acute injuries with indeterminate clinical
findings, using arthroscopy as a gold standard. DESIGN: A prospective
double-blind study was performed. All patients underwent MRI on a 1.5 T
magnet using dual spin echo pulse sequences. This was followed by
arthroscopy. SETTING: Tertiary care referral center. PATIENTS: Twentythree patients with an average age of 26 years satisfied the study
criteria. Patients had to have been seen by one of two orthopaedic
surgeons within 6 weeks of sudden trauma to the knee complicated by a
hemarthrosis, clinical assessment of which was equivocal. RESULTS: The
respective sensitivity and specificity for MRI of the knee were 90%
(18/20) and 67% (2/3) for detecting any anterior cruciate ligament
injury, 50% (1/2) and 86% (18/21) for detecting medial meniscal tears,
and 88% (7/8) and 73% (11/15) for detecting lateral meniscal tears. MRI
also identified injuries that could not be assessed on arthroscopy,
including 14 bone bruises, five posterior cruciate ligament tears, nine
medial collateral ligament tears, and one lateral collateral ligament
tear. The detection of composite injury requiring surgical intervention
yielded a sensitivity of 100% (16/16) and a specificity of 71% (5/7).
Prospective use of MRI evaluation of the knee could have prevented 22%
(5/23) of diagnostic arthroscopic procedures. CONCLUSION: Equivocal
clinical findings in patients with acute knee injury should lead to use
of MRI in an appropriate clinical setting. To our knowledge a prospective
study of the efficacy of MRI of the knee in this patient population has
not been reported. In the presence of such inclusion criteria, the
results of our study support the use of early MRI to guide further
surgical management.
<18>
Unique Identifier
9007366
Medline Identifier
97159850
Authors
Colletti P. Greenberg H. Terk MR.
Institution
LAC-USC Imaging Science Center 90033, USA.
Title
MR findings in patients with acute tibial plateau fractures.
Source
Computerized Medical Imaging & Graphics. 20(5):389-94, 1996 Sep-Oct.
Abstract
OBJECTIVE: The purpose of this study was to demonstrate the MRI
findings associated with acute tibial plateau fractures. MATERIALS AND
METHODS: MR scans of 29 patients with acute tibial plateau fractures were
analyzed retrospectively. The images were evaluated for the presence of
injuries involving the menisci, cruciate and collateral ligaments. The
presence of a lipohemarthrosis or a simple joint effusion was also noted.
The tibial plateau fractures were classified according to the scheme
devised by Schatzker. RESULTS: Evidence of internal derangement of the
knee was found in 28 (97%) patients. Tibial collateral ligament (55%)
injuries and lateral meniscus (45%) tears were noted most frequently.
Medial meniscus tears were seen in 21% and fibular collateral ligament
injuries were diagnosed in 34%. Forty-one percent had anterior cruciate
ligament injuries while the posterior cruciate ligament was injured in
28%. Twelve (41%) patients demonstrated the characteristic MRI features
of a lipohemarthrosis. Simple joint effusions were found in the remaining
17 (59%) patients. CONCLUSION: MR imaging in patients with acute tibial
plateau fractures commonly demonstrates associated ligamentous and
meniscal injuries. By imaging in multiple planes, MRI can aid in the
accurate characterization of tibial plateau fracture patterns and
severity.
<19>
Unique Identifier
9639983
Medline Identifier
98304165
Authors
Scoggin JF 3rd.
Institution
Department of Orthopaedic, Surgery and Sports Medicine, Straub Clinic &
Hospital, Honolulu, Hawaii 96813, USA.
Title
Common sports injuries seen by the primary care physician. Part II:
Lower extremity.
Source
Hawaii Medical Journal. 57(5):502-5, 1998 May.
Abstract
Sports medicine is the science of caring for the medical and surgical
needs of athletes and their injuries. Injuries of the upper extremity
were dealt with in Part I in a previous article. Part II deals with
injuries of the lower extremity. Trochanteric bursitis and hamstring
strains are treated with rest, rehabilitation, and correction of training
errors. Patellofemoral pain syndromes require accurate diagnosis and
usually a rehabilitative program. Injuries to the medial collateral
ligament are very common, but can be associated with tears of the
meniscus and cruciate ligaments. The latter two often require surgical
intervention. Ankle sprains are graded by severity. The most severe can
result in chronic pain or instability, but most respond well to
functional bracing and progressive return to activity.
<20>
Unique Identifier
8727746
Medline Identifier
96284376
Authors
Shelbourne KD. Patel DV.
Institution
Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
Title
Management of combined injuries of the anterior cruciate and medial
collateral ligaments.
Source
Instructional Course Lectures. 45:275-80, 1996.
<21>
Unique Identifier
8739577
Medline Identifier
96320798
Authors
Lundberg M. Odensten M. Thuomas KA. Messner K.
Institution
Department of Orthopedics and Sports Medicine, University Hospital,
Linkoping, Sweden.
Title
The diagnostic validity of magnetic resonance imaging in acute knee
injuries with hemarthrosis. A single-blinded evaluation in 69 patients
using high-field MRI before arthroscopy.
Source
International Journal of Sports Medicine. 17(3):218-22, 1996 Apr.
Abstract
Sixty-nine patients with traumatic knee hemarthrosis were evaluated an
average of 3 days after trauma by high field (1.5T) magnetic resonance
imaging (MRI) using sagittal T1, T2-weighted and coronal 3D-gradient echo
images. All knees were arthroscopically examined shortly afterwards. The
diagnostic validity of MRI for intraarticular pathology was determined
using arthroscopy as golden standard. All patients had pathological
findings on arthroscopy. The injuries were sports-related in 77% of the
cases. MRI was highly sensitive (86%) and specific (92%) for diagnosis of
anterior cruciate ligament tears. Diagnosis of medial meniscal tears
showed a 74% sensitivity and 66% specificity. MRI detected lateral
meniscal tears in 50% with an 84% specificity. As such, MRI missed 10
significant meniscus ruptures requiring surgical treatment. The
sensitivity for partial or total medial collateral ligament tears was
56%, the specificity 93%. Rupture of the medial retinaculum in cases with
patellar dislocation or significant damage of articular cartilage were
only detected by MRI in a few cases (27% and 20% sensitivity,
respectively). MRIs low diagnostic validity for intraarticular pathology
with hemarthrosis may be attributed to the shifting paramagnetic
properties of the blood remains and catabolic processes in meniscal and
chondral tissues during the hemoglobin degradation process. Accordingly,
MRI, with the technique used, could neither replace arthroscopy in the
diagnosis and screening of acute knee injuries, nor select patients with
need for immediate arthroscopic meniscal surgery.
<22>
Unique Identifier
10894382
Medline Identifier
20350880
Authors
Shirakura K. Terauchi M. Katayama M. Watanabe H. Yamaji T.
Takagishi K.
Institution
Department of Orthopaedic Surgery, Gunma University Faculty of
Medicine, Japan. kshiraku@akagi.sb.gunma-u.ac.jp
Title
The management of medial ligament tears in patients with combined
anterior cruciate and medial ligament lesions.
Source
International Orthopaedics. 24(2):108-11, 2000.
Abstract
The management of patients with combined medial collateral (MCL) and
anterior cruciate (ACL) rupture remains controversial. We studied 25 such
patients who elected to have the ACL lesion treated conservatively; 14
underwent MCL repair with early mobilization and 11 were treated with
immobilization for two weeks. The mean follow up was 5.9 years (2 to 11).
There was no difference in the clinical assessment of ligamentous laxity,
KT-1000 measurements or Tegner activity scores between the two groups but
there were significantly higher Lysholm function scores in the operated
group.
<23>
Unique Identifier
9109554
Medline Identifier
97263639
Authors
Woo SL. Chan SS. Yamaji T.
Institution
Musculoskeletal Research Center, Department of Orthopaedic Surgery,
University of Pittsburgh, PA 15213, USA.
Title
Biomechanics of knee ligament healing, repair and reconstruction.
[Review] [68 refs]
Source
Journal of Biomechanics. 30(5):431-9, 1997 May.
Abstract
Injuries of the anterior cruciate ligament (ACL) and the medial
collateral ligament (MCL) are common, accounting for 90% of all knee
ligament injuries in young and active individuals. During the last
decade, our research center has focused on MCL healing and ACL
reconstruction. We have found that the MCL heals without intervention
after an isolated injury, and that primary repair offers no apparent
advantage. After a combined injury of the ACL and MCL, the ACL requires
reconstruction, whereas primary repair again contributes little or
nothing toward MCL healing. Midsubstance ACL injuries have limited
healing ability. Hence, the treatment of choice for a torn ACL in a
young, active patient is generally reconstruction with an autograft or
allograft. However, the appropriate replacement graft and reconstruction
technique to use are still debated. Current research efforts have been
placed on investigating the magnitude and direction of in situ forces in
the human ACL. We use a six-component universal force moment sensor
combined with a six-degree-of-freedom (DOF) robotic manipulator to learn
as well as to reproduce the six-DOF motion of the knee before and after
ACL injury. This way, the in situ force in the ACL under an anterior
posterior tibial load of 110 N was obtained. This methodology should make
it possible to obtain the needed data to aid in better understanding of
ACL reconstruction and possible development of improved clinical
management. [References: 68]
<24>
Unique Identifier
11205863
Medline Identifier
21073836
Authors
Leopold SS. McStay C. Klafeta K. Jacobs JJ. Berger RA. Rosenberg
AG.
Institution
Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 60612,
USA.
Title
Primary repair of intraoperative disruption of the medical collateral
ligament during total knee arthroplasty.
Source
Journal of Bone & Joint Surgery. 83-A(1):86-91, 2001 Jan.
Abstract
BACKGROUND: Intraoperative disruption of the medial collateral ligament
during total knee arthroplasty is an uncommon complication that is
frequently treated by implanting a prosthesis with varus-valgus
constraint. To our knowledge, no data have been published on primary
repair or reattachment of the medial collateral ligament and implantation
of a minimally constrained posterior-stabilized or cruciate-retaining
prosthesis. This retrospective study evaluates the hypothesis that
satisfactory clinical results, at a minimum of two years, can be achieved
with immediate repair or reattachment of the medial collateral ligament
and without a constrained total knee prosthesis. METHODS: Of 600 knees
treated with primary total knee arthroplasty, sixteen (in fourteen
patients) sustained either a midsubstance disruption of the medial
collateral ligament or an avulsion of the ligament from bone during the
procedure. Preoperatively, all patients had either neutral or varus
alignment and an intact medial collateral ligament. Midsubstance tears
were treated with direct primary repair, and avulsions of the ligament
off the tibia or femur were treated with suture-anchor reattachment to
bone. All patients wore a hinged knee brace, with no limit to the range
of motion, for six weeks postoperatively. Clinical and radiographic data
were gathered prospectively as part of a database that was ongoing
throughout the period of study; the cohort of patients was assembled
retrospectively by searching that database. RESULTS: No patients were
lost to follow-up. The mean duration of follow-up was forty-five months
(range, twenty-four to ninety-five months). The Hospital for Special
Surgery knee scores increased from a mean of 47 points (poor)
preoperatively to a mean of 93 points (excellent) at the time of final
follow-up. On physical examination, no patient had a Hospital for Special
Surgery score in the fair or poor range and all patients had regained
normal stability in the coronal plane both at full extension and at 30
degrees of flexion. No patient required knee-bracing beyond the initial
six-week postoperative period. The range of motion at the time of final
follow-up averaged 108 degrees (range, 85 degrees to 125 degrees ),
although one knee required manipulation under anesthesia to obtain a
satisfactory range of motion. No arthroplasties required revision.
Radiographic examination demonstrated appropriate limb alignment in all
patients at the time of final follow-up. CONCLUSIONS: Intraoperative
disruption of the medial collateral ligament can be treated with primary
repair or reattachment of the ligament to bone and postoperative bracing
with good results; this avoids the potential disadvantages associated
with the use of varus-valgus constrained implants.
<25>
Unique Identifier
8609106
Medline Identifier
96190455
Authors
Hillard-Sembell D. Daniel DM. Stone ML. Dobson BE. Fithian DC.
Institution
San Diego Kaiser Medical Center, California, USA.
Title
Combined injuries of the anterior cruciate and medial collateral
ligaments of the knee. Effect of treatment on stability and function of
the joint.
Source
Journal of Bone & Joint Surgery. 78(2):169-76, 1996 Feb.
Abstract
We performed a retrospective study of sixty-six patients (forty-one
male and twenty-five female) who had a combined injury of the anterior
cruciate and medial collateral ligaments. Our purpose was to determine
the prevalence of late valgus instability of the knee. The mean age of
the patients was thirty-five years (range, sixteen to sixty-three years).
The mean follow-up interval was forty-five months (range, twenty-one to
108 months). Twenty patients had been injured while snow-skiing; twentyfour, during other sports activities; seven, in a motor-vehicle accident;
and the remaining fifteen, during activities of daily living. Eleven
patients had reconstruction of the anterior cruciate ligament and repair
of the medial collateral ligament, thirty-three had reconstruction of
only the anterior cruciate ligament, and twenty-two were managed nonoperatively. There was no evidence of valgus instability on clinical
examination at the most recent follow-up visit. However, there was
evidence of instability on stress roentgenograms of the knee in eight (13
per cent) of sixty patients. With the numbers available, we could detect
no relationship between the presence of valgus instability and the method
of treatment of the ligamentous tears ( p > 0.4). We also compared the
results for twenty-one of the thirty-three patients who had a combined
ligamentous injury and reconstruction of only the anterior cruciate
ligament with those for thirty-seven patients who had reconstruction of
an isolated tear of the anterior cruciate ligament. After a mean followup interval of thirty-five months (range, twenty-one to sixty-six
months), there was no difference in the anterior displacement, impairment
of function, level of participation in sports activities, results of the
one-leg-hop for distance test, or strength as determined by testing on a
Cybex machine. On the basis of the findings in this study, we believe
that, when there is mild or moderate valgus instability, an injury of the
medial collateral ligament does not need to be repaired when the anterior
cruciate ligament is repaired after a combined ligamentous injury.
<26>
Unique Identifier
10633898
Medline Identifier
20099715
Authors
Eygendaal D. Olsen BS. Jensen SL. Seki A. Sojbjerg JO.
Institution
Department of Orthopaedic Surgery, Academic Hospital Leiden, The
Netherlands.
Title
Kinematics of partial and total ruptures of the medial collateral
ligament of the elbow.
Source
Journal of Shoulder & Elbow Surgery. 8(6):612-6, 1999 Nov-Dec.
Abstract
In this study the kinematics of partial and total ruptures of the
medial collateral ligament of the elbow are investigated. After selective
transection of the medial collateral ligament of 8 osteoligamentous
intact elbow preparations was performed, 3-dimensional measurements of
angular displacement, increase in medial joint opening, and translation
of the radial head were examined during application of relevant stress.
Increase in joint opening was significant only after complete transection
of the anterior part of the medial collateral ligament was performed. The
joint opening was detected during valgus and internal rotatory stress
only. After partial transection of the anterior bundle of the medial
collateral ligament was performed, there was an elbow laxity to valgus
and internal rotatory force, which became significant after transection
of 100% of the anterior bundle of the medial collateral ligament and was
maximum between 70 degrees to 90 degrees of flexion. No radial head
movement was seen after partial or total transection of the anterior
bundle of the medial collateral ligament was performed. In conclusion,
this study indicates that valgus or internal rotatory elbow instability
should be evaluated at 70 degrees to 90 degrees of flexion. Detection of
partial ruptures in the anterior bundle of the medial collateral ligament
based on medial joint opening and increased valgus movement is
impossible.
<27>
Unique Identifier
8898522
Medline Identifier
97054143
Authors
Malanga GA. Smith HM.
Institution
Department of Physical Medicine and Rehab, Mayo Clinic, Rochester, MN
55905, USA.
Title
Lower extremity injuries in in-line skaters: a report of two cases.
Source
Journal of Sports Medicine & Physical Fitness. 36(2):139-42, 1996 Jun.
Abstract
In-line skating has become a very popular sport over the past several
years. Previous studies examining the injuries associated with this sport
have emphasized the incidence upper extremity injuries. Two cases are
described in which patients suffered severe lower extremity injuries
while in-line skating: one had a femoral shaft spiral fracture and the
other bilateral anterior cruciate ligament and medial collateral ligament
injuries. Although a predominance of upper extremity injuries associated
with this sport has been widely noted, increased numbers of participants,
higher speeds and changing skate designs may further predispose skaters
to leg, knee and ankle injuries.
<28>
Unique Identifier
9604195
Medline Identifier
98267554
Authors
Frolke JP. Oskam J.
Institution
Vierhout PA.
Department of Traumatology, Free University Hospital, Amsterdam, The
Netherlands.
Title
Primary reconstruction of the medial collateral ligament in combined
injury of the medial collateral and anterior cruciate ligaments. Shortterm results.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 6(2):103-6, 1998.
Abstract
We describe our experiences with 22 patients who underwent acute
surgical intervention for complete combined injury of the anterior
cruciate ligament (ACL) and medial collateral ligament (MCL) in our
hospital. In all patients, an arthroscopically guided repair of the MCL
was performed, while the torn ACL was treated non-surgically. Primary
reconstruction of the MCL in patients with complete disruptions of the
MCL complex as well as the ACL reduces combined anteromedial instability
to an isolated problem of the ACL. As a result of this treatment, the
condition of 15 of 22 knees was improved, after an average duration of
follow-up of 2 and a half years. In conclusion, our treatment strategy of
an immediate repair of the MCL and reconstruction of the ACL when
conservative treatment has failed seems safe and effective.
<29>
Unique Identifier
9728679
Medline Identifier
98396872
Authors
Abdel-Rahman EM. Hefzy MS.
Institution
Department of Mechanical, Industrial and Manufacturing Engineering, The
University of Toledo, OH 43606, USA.
Title
Three-dimensional dynamic behaviour of the human knee joint under
impact loading.
Source
Medical Engineering & Physics. 20(4):276-90, 1998 Jun.
Abstract
The objective of this study is to determine the three-dimensional
dynamic response of the human knee joint. A three-dimensional anatomical
dynamic model was thus developed and consists of two body segments in
contact (the femur and tibia) executing a general three-dimensional
dynamic motion within the constraints of the different ligamentous
structures. Each of the articular surfaces at the tibio-femoral joint was
represented mathematically by a separate mathematical function. The joint
ligaments were modelled as nonlinear elastic springs. The six-degrees-offreedom joint motions were characterized by using six kinematic
parameters, and ligamentous forces were expressed in terms of these six
parameters. Knee response was studied by considering sudden external
forcing pulse loads applied to the tibia. Model equations consist of
nonlinear second-order ordinary differential equations coupled with
nonlinear algebraic constraint conditions. Constraint equations were
written to maintain at least one-point contact throughout motion; one-
and two-point contact versions of the model were developed. This
Differential-Algebraic Equations (DAE) system was solved by employing a
DAE solver: the Differential/Algebraic System Solver (DASSL) developed at
Lawrence Livermore National Laboratory. A solution representing the
response of this three-dimensional dynamic system was thus obtained for
the first time. Earlier attempts to determine the system's response were
unsuccessful owing to the inherent numerical instabilities in the system
and the limitations of the solution techniques. Under the conditions
tested, evidence of "femoral roll back" on both medial and lateral tibial
plateaus was not observed from the model predictions. In the range of 20
degrees to 66 degrees of knee flexion, the lateral tibial contact point
moved posteriorly while the medial tibial contact point moved anteriorly.
In the range of 66 degrees to 90 degrees of knee flexion, contact was
maintained only on the medial side and the tibial contact point (on the
medial side) continued to move anteriorly. It was further found that
increasing pulse amplitude and/or duration caused a decrease in the
magnitude of the tibio-femoral contact force at a given flexion angle.
These results suggest that increasing load level caused a decrease in
joint stiffness. The results of this study also show that the anterior
fibres of the posterior cruciate and the medial collateral ligaments are
the primary restraints for a posterior forcing pulse in the range of 20
degrees to 90 degrees of knee flexion; this explains why most isolated
posterior cruciate ligament injuries and combined injuries to the
posterior cruciate and the medial collateral result from a posterior
impact on a flexed knee.
<30>
Unique Identifier
11046165
Medline Identifier
20501343
Authors
Recondo JA. Salvador E. Villanua JA. Barrera MC. Gervas C.
Alustiza JM.
Institution
Department of Magnetic Resonance, Osatek, Hospital Aranzazu, Complejo
Hospitalario Donostia, Paseo Doctor Beguiristain 109, 20014 San
Sebastian, Spain. rm.donostia@ostatek.es
Title
Lateral stabilizing structures of the knee: functional anatomy and
injuries assessed with MR imaging.
Source
Radiographics. 20 Spec No:S91-S102, 2000 Oct.
Abstract
The lateral aspect of the knee is stabilized by a complex arrangement
of ligaments, tendons, and muscles. These structures can be demonstrated
with routine spin-echo magnetic resonance (MR) imaging sequences
performed in the sagittal, coronal, and axial planes. Anterolateral
stabilization is provided by the capsule and iliotibial tract.
Posterolateral stabilization is provided by the arcuate ligament complex,
which comprises the lateral collateral ligament; biceps femoris tendon;
popliteus muscle and tendon; popliteal meniscal and popliteal fibular
ligaments; oblique popliteal, arcuate, and fabellofibular ligaments; and
lateral gastrocnemius muscle. Injuries to lateral knee structures are
less common than injuries to medial knee structures but may be more
disabling. Most lateral compartment injuries are associated with damage
to the cruciate ligaments and medial knee structures. Moreover, such
injuries are frequently overlooked at clinical examination. Structures of
the anterolateral quadrant are the most frequently injured;
posterolateral instability is considerably less common. Practically all
tears of the lateral collateral ligament are associated with damage to
posterolateral knee structures. Most injuries of the popliteus muscle and
tendon are associated with damage to other knee structures. MR imaging
can demonstrate these injuries. Familiarity with the musculotendinous
anatomy of the knee will facilitate accurate diagnosis with MR imaging.
<31>
Unique Identifier
10512209
Medline Identifier
99440760
Authors
Larsen E. Jensen PK. Jensen PR.
Institution
Gildhoj Speciallaegeklinik, Copenhagen, Denmark.
Title
Long-term outcome of knee and ankle injuries in elite football.
Source
Scandinavian Journal of Medicine & Science in Sports. 9(5):285-9, 1999
Oct.
Abstract
To estimate the risk and evaluate the long-term outcome of knee and
ankle injuries in former national team elite football, 69 players were
randomly selected, followed by clinical and stress radiographic
examinations. Thirty-nine players (49 knees) had had knee injuries and 29
ankle injuries (35 ankles). The median time from injury until study
examination was 25 years. The knee injuries were tears of the medial
collateral ligament (MCL) in 24 cases combined with rupture of the
anterior cruciate ligament (ACL) and meniscus lesions in three. Meniscus
lesions had occurred in 17 cases including three combined with ACL and
MCL and another two with ACL ruptures. Isolated rupture of the ACL had
occurred in four cases. The ankle lesions were in 26 of 35 cases ruptures
of the lateral ligaments. In all, 12 players had completely stopped
football and three had changed occupation. Signs of arthritis were
present in 63% of the injured knees and in 33% of the injured ankles. The
incidence of arthritis in the group of 17 uninjured players was 26% in
the knee and 18% the ankle. In elite football players knee and ankle
injuries seem to have a serious long-term outcome, but also uninjured
players have a higher risk of developing arthritis than the normal
population.
<32>
Unique Identifier
10591931
Medline Identifier
20059954
Authors
Patel JJ.
Institution
Department of Radiology, Baystate Medical Center, 759 Chestnut Street,
Springfield, MA 01199, USA.
Title
Intra-articular entrapment of the medial collateral ligament:
radiographic and MRI findings.
Source
Skeletal Radiology. 28(11):658-60, 1999 Nov.
Abstract
Displacement of the medial collateral ligament (MCL) into the medial
knee joint is an extremely rare finding associated with MCL tears, and is
easily diagnosed on magnetic resonance imaging. A case of intra-articular
interposition of the MCL during a severe knee injury is presented. A
radiolucent "fat stripe" sign and adjacent skin dimpling on radiographs
may be relatively specific indicators of this injury.