MCL Cluster | Diagnosting Medial Collateral Ligament Injuries

Kastelein et al. (2008) conducted a study to investigate the diagnostic accuracy of patient history items as well as orthopedic tests to assess the integrity of the MCL. In total, 36 variables from patient history, mechanism of injury, signs of trauma, present symptoms during the first consultation as well as findings from the physical examination were included in their model. Ultimately, four variables made it into the model – 2 findings from patient history, namely trauma by an external force to the leg and rotational trauma, and 2 from physical examination: Pain during the valgus stress test at 30° as well as laxity during the test.

In the case at least 1 out of 2 findings from patient history AND pain is reproduced during the valgus stress test at 30° is present, the positive likelihood ratio of an MCL lesion as confirmed during MRI is 4.8. In the case that laxity is also increased during the valgus stress test the positive likelihood ratio rises to 6.4. In case only one finding from patient history is present and no physical examination findings are positive, the presence of an MCL lesion can reasonably be excluded and reduce the number of unnecessary referrals for imaging. And even if a lesion is suspected, granted in the absence of knee locking or suspicion of a fracture, the recommendation based on clinical practice guidelines remains that of a conservative approach.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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If you want to learn how to perform the Valgus Stress Test that is mentioned in the cluster, click on the test name.

References

Kastelein M, Wagemakers HP, Luijsterburg PA, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Assessing medial collateral ligament knee lesions in general practice. The American journal of medicine. 2008 Nov 1;121(11):982-8.