Diagnostic tests
1st tests to order
1st tests to ordertable-forMedial collateral ligament injury
| Test | Result |
- plain x-rays of knee
-
Ordered in accordance with the Ottawa knee rules to exclude bony injury. Anteroposterior, lateral, and patellofemoral views are often sufficient.
Pellegrini-Stieda lesions (a calcification that develops adjacent to the adductor tubercle) suggest a collateral ligament injury that is more than 6 weeks old. They are best seen in the anteroposterior view.
| may show associated fracture of the tibial plateau, patella, or distal femur; calcification adjacent to the adductor tubercle is typical of a Pellegrini-Stieda lesion in chronic situations |
- stress x-rays of knee (adolescent patients)
-
Stress radiography x-rays taken with a valgus load on a partially flexed knee should be ordered in adolescents to rule out physeal injuries.
| greater than normal opening on the medial side of the knee joint is commonly seen; physeal fractures may be seen in adolescents |
Tests to consider
Tests to considertable-forMedial collateral ligament injury
| Test | Result |
- MRI of knee
-
Provides excellent visualisation of soft tissue anatomy and is indicated if any associated injuries are suspected.
MRI is also useful for identifying the precise location of the MCL tear on the ligament, which is usually visible on T2-weighted images.
| MCL tear appearing as a high signal of oedema and haemorrhage in the low-signal ligament; may also show meniscal tear, ACL or PCL tear, bone bruise, osteochondral fracture |
Emerging tests
Emerging teststable-forMedial collateral ligament injury
| Test | Result |
- diagnostic ultrasound
-
Ultrasound is emerging as an excellent and efficient means for visualising the knee. It is frequently used in Europe, South America, and Asia because of its inexpensive costs. MCL tears as well as associated injuries may be visualised with a knee ultrasound. However, grade III MCL injuries (complete tears) are difficult to diagnose with ultrasound because of the irregular nature of ligament tearing.
| MCL appears thickened and hypo-echoic (from oedema); fluid collection may be highest near the location of the tears; Pellegrini-Stieda lesions show up as calcifications within thickened and hypo-echoic ligament tissue. |
Last updated: Apr 26, 2013
