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Key Features

  • Medial injuries occur either with a blow to the lateral aspect of the knee, as seen in a football tackle, or with a noncontact rotational stress

  • Medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries are graded on a scale of 1–3

    • Grade 1 injury represents a stretching injury

    • Grade 2 injury involves partial disruption of the ligament

    • Grade 3 injury is a complete disruption of the ligament

  • Return to sports

    • Variable and depends on severity of the tear and other associated injuries

    • Most athletes with isolated, low-grade MCL injuries can return to play in 3–5 weeks

Clinical Findings

  • The athlete may feel a pop or pain sensation along the medial or lateral aspect of the knee

  • Examination reveals a mild effusion and tenderness medially along the course of the ligament


  • A valgus stress test performed in 20–30 degrees of flexion reproduces pain and possibly instability in medial collateral ligament injuries

  • A varus stress test performed in 20–30 degrees of flexion reproduces pain and possible instability in lateral collateral ligament injuries

  • Radiographs are useful, especially in the skeletally immature athlete, to look for distal femoral or proximal tibial bone injury

  • MRI scans are used if grade 3 injury or concomitant intra-articular derangement is suspected


  • Conservative

    • Ice and elevation initially

    • A protective brace is worn and full knee motion in the brace can be permitted within a few days

    • Weight bearing is allowed and a strengthening program can be started

    • The athlete should use the brace until pain and range of motion have improved

  • Bracing is temporary until the ligament heals completely and the athlete has no subjective feelings of instability

  • The use of a functional brace is often required when a player returns to competition

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