Presentation
Knee pain after trauma
Patient Data
Grade 2 medial collateral ligament injury, as partial disruption of the femoral attachment of MCL and oedema signal superficial to the ligament. Associated avulsion injury of the medial femoral condyle at the MCL attachment site, which is also called a "Stieda fracture". Low-grade sprain of the posterior oblique ligament.
Horizontal tearing at the body and posterior horn of the lateral meniscus, involving both meniscal surfaces. The medial meniscus is intact.
High-grade partial tearing of the ACL.
Bone contusion at the fibular head, lateral tibial plateau, and medial border of the medial tibial plateau along the attachment site of the medial meniscotibial fibres of deep MCL.
Moderate-sized joint effusion and a 37 mm popliteal cyst.
Chondromalacia patella grade 2.
Findings collectively suggest high-impact valgus force to the knee with resultant MCL avulsion injury, high-grade ACL tear, and low-grade posterior oblique ligament sprain and lateral meniscal tear.
Case Discussion
Comprised of deep and superficial layers, the medial collateral ligament is an important knee stabiliser. The two major mechanisms of MCL injury are valgus force to a flexed knee, and pivot shift.
Avulsion injuries are less common, and occur at MCL tibial attachment (i.e. reverse Segond fracture) or femoral attachment (i.e. Stieda fracture).
There is a high association between Stieda fracture and ACL injury, and as a result this fracture, when encountered, should raise the suspicion to detect for more concomitant ligamentous tears.
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