Medial collateral ligament bursitis or tibial collateral ligament bursitis is the acute or chronic inflammation of the medial collateral ligament bursa which is located between the superficial and deep layers of the medial collateral ligament 1-5.
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Epidemiology
In isolation, medial collateral ligament bursitis is extremely rare 2.
Associations
knee arthritis 2
overuse (e.g. riding or motorcycling)
Diagnosis
Nowadays the diagnosis might be established by the combination of typical clinical symptoms and evidence of typical imaging appearance of a distended medial collateral ligament bursa as well as the documented absence of a medial collateral ligament injury and a medial meniscal tear 4.
Clinical presentation
Clinically medial collateral ligament bursitis may present as swelling, pain and tenderness at the medial aspect of the knee in the area of the joint line 5. The pain might get more severe with knee extension.
Pathology
Pathologically this is an inflammatory process affecting the synovial lining of a bursa, which then becomes distended 1-4. This might happen due to mechanical friction or in association with autoimmune disease or rheumatological disorders 3,4.
Radiographic features
Typical radiographic features on imaging include the following 4:
distended bursa
absence of medial collateral injury
absence of related meniscal tear
Ultrasound
On ultrasound medial collateral bursitis can be seen as a well-defined fluid collection between the superficial and deep portions of the medial collateral ligament 4,6.
MRI
Medial collateral ligament bursitis will usually appear as a well-defined fluid-filled sac or bursa between the superficial and deep fibers of the medial collateral ligament 1.
Signal characteristics
T1: hypointense
T2: hyperintense
Radiology report
The description should contain the following:
presence of fluid between the superficial and deep fibers of the medial collateral ligament
presence of inflammatory change
absence of meniscal tear and or displacement
Treatment and prognosis
Treatment is usually conservative 4,5 and might include a short course of nonsteroidal anti-inflammatory drugs or other pain medications as well as local application of ice, strengthening and stretching exercises to alleviate the pain. Activity modifications should be considered if overuse or a specific activity has caused the bursitis. Additional options include ultrasound-guided cortisone and lidocaine injections to reduce inflammation and pain 5. Recalcitrant cases might require arthroscopy 5 and calcificic bursitis can be additionally treated by shockwave therapy or ultrasound-guided percutaneous lavage 6.
History and etymology
The medial collateral ligament bursa was first described by the American surgeon and surgical anatomist Otto C Brantigan and the orthopedic surgeon Allen F Voshell in 1943 7. The disorder was later further characterized by the radiologist Robert K Kerlan and orthopedic surgeon Ronald E Glousman in 1988 4.
Differential diagnosis
On imaging studies, medial collateral ligament bursitis might be mimicked by the following 1,2,8:
meniscocapsular separation: peripheral tear of the medial meniscus and meniscal displacement