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Medial collateral ligament

The medial collateral ligament (MCL), also called the superficial medial collateral ligament (sMCL) or tibial collateral ligament (TCL),[1] is one of the major ligaments of the knee. It is on the medial (inner) side of the knee joint and occurs in humans and other primates. Its primary function is to resist valgus (inward bending) forces on the knee.

Medial collateral ligament
Right knee anatomy. The medial collateral ligament is wide and flat, found on the medial side of the joint. Proximally, it attaches to the medial epicondyle of the femur, distally it attaches to the medial condyle of the tibia.
Details
Frommedial epicondyle of the femur
Tomedial condyle of tibia
Identifiers
LatinLigamentum collaterale tibiale
MeSHD017888
TA98A03.6.08.012
TA21896
FMA44600
Anatomical terminology
[edit on Wikidata]

Structure

It is a broad, flat, membranous band, situated slightly posterior on the medial side of the knee joint. It is attached proximally to the medial epicondyle of the femur immediately below the adductor tubercle; below to the medial condyle of the tibia and medial surface of its body.[2]

It resists forces that would push the knee medially, which would otherwise produce valgus deformity. It provides up to 78% of the restraining force that resists valgus (inward pressing) loads on the knee.[3]

The fibers of the posterior part of the ligament are short and incline backward as they descend; they are inserted into the tibia above the groove for the semimembranosus muscle.

The anterior part of the ligament is a flattened band, about 10 centimeters long, which inclines forward as it descends.

It is inserted into the medial surface of the body of the tibia about 2.5 centimeters below the level of the condyle.

Crossing on top of the lower part of the MCL is the pes anserinus, the joined tendons of the sartorius, gracilis, and semitendinosus muscles; a bursa is interposed between the two.

The MCL's deep surface covers the inferior medial genicular vessels and nerve and the anterior portion of the tendon of the semimembranosus muscle, with which it is connected by a few fibers; it is intimately adherent to the medial meniscus.[4]

Development

Embryologically and phylogenically, the ligament represents the distal portion of the tendon of adductor magnus muscle. In lower animals, adductor magnus inserts into the tibia. Because of this, the ligament occasionally contains muscle fibres. This is an atavistic variation.

Clinical significance

Injury

An MCL injury can be very painful and is caused by a valgus stress to a slightly bent knee, often when landing, bending or on high impact. It may be difficult to apply pressure on the injured leg for at least a few days. It can be caused by a direct blow to lateral side of knee. The most common knee structure damaged in skiing is the medial collateral ligament, although the carve turn has diminished the incidence somewhat.[5] MCL strains and tears are also fairly common in American football. The center and the guards are the most common victims of this type of injury due to the grip trend on their cleats, although sometimes it can be caused by a helmet striking the knee. The number of football players who get this injury has increased in recent years. Companies are currently trying to develop better cleats that will prevent the injury. MCL is also crucially affected in breaststroke and many professional swimmers suffer from chronic MCL pains.

There are three distinct levels in a MCL injury. Grade 1 is a minor sprain, grade 2 in a major sprain or a minor tear, and grade 3 is a major tear. Based on the grade of the injury treatment options will vary.[6]

Treatment

Depending on the grade of the injury, the lowest grade (grade 1) can take between 2 and 10 weeks for the injury to fully heal. Recovery times for grades 2 and 3 can take several weeks to several months.

Treatment of a partial tear or stretch injury is usually conservative. Most injuries that are partial and isolated can be treated without surgery.[3] This includes measures to control inflammation as well as bracing. Kannus has shown good clinical results with conservative care of grade II sprains, but poor results in grade III sprains.[7] As a result, more severe grade III and IV injuries to the MCL that lead to ongoing instability may require arthroscopic surgery. However, the medical literature considers surgery for most MCL injuries to be controversial.[8] Isolated MCL sprains are common.[citation needed]

Additional images

See also

References

  1. ^ LaPrade, R. F.; Engebretsen, A. H.; Ly, T. V.; Johansen, S.; Wentorf, F. A.; Engebretsen, L. (2007). "The anatomy of the medial part of the knee". J Bone Joint Surg Am. 89 (9): 2000–2010. doi:10.2106/JBJS.F.01176. PMID 17768198. S2CID 46253119.
  2. ^ Gray's anatomy : the anatomical basis of clinical practice. Susan Standring (Forty-first ed.). [Philadelphia]. 2016. ISBN 978-0-7020-5230-9. OCLC 920806541.{{cite book}}: CS1 maint: others (link)
  3. ^ a b Kovachevich, Rudy; Shah, Jay P.; Arens, Annie M.; Stuart, Michael J.; Dahm, Diane L.; Levy, Bruce A. (2009-05-07). "Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review". Knee Surgery, Sports Traumatology, Arthroscopy. 17 (7): 823–829. doi:10.1007/s00167-009-0810-4. ISSN 0942-2056. PMID 19421735. S2CID 22198296.
  4. ^ Gray's anatomy : the anatomical basis of clinical practice. Susan Standring (Forty-first ed.). [Philadelphia]. 2016. ISBN 978-0-7020-5230-9. OCLC 920806541.{{cite book}}: CS1 maint: others (link)
  5. ^ . www.ski-injury.com. Archived from the original on October 16, 2013. Retrieved October 13, 2013.[unreliable medical source?]
  6. ^ "Medial Collateral Ligament Injury Grading". Radiopaedia.org.
  7. ^ Kannus, P (1988). "Long-term results of conservatively treated medial collateral ligament injuries of the knee joint". Clinical Orthopaedics and Related Research. 226 (226): 103–12. doi:10.1097/00003086-198801000-00015. PMID 3335084.
  8. ^ Indelicato, P. A. (1995). "Isolated Medial Collateral Ligament Injuries in the Knee". The Journal of the American Academy of Orthopaedic Surgeons. 3 (1): 9–14. doi:10.5435/00124635-199501000-00002. PMID 10790648. S2CID 2266550.

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This article s lead section may be too short to adequately summarize the key points Please consider expanding the lead to provide an accessible overview of all important aspects of the article June 2010 The medial collateral ligament MCL also called the superficial medial collateral ligament sMCL or tibial collateral ligament TCL 1 is one of the major ligaments of the knee It is on the medial inner side of the knee joint and occurs in humans and other primates Its primary function is to resist valgus inward bending forces on the knee Medial collateral ligamentRight knee anatomy The medial collateral ligament is wide and flat found on the medial side of the joint Proximally it attaches to the medial epicondyle of the femur distally it attaches to the medial condyle of the tibia DetailsFrommedial epicondyle of the femurTomedial condyle of tibiaIdentifiersLatinLigamentum collaterale tibialeMeSHD017888TA98A03 6 08 012TA21896FMA44600Anatomical terminology edit on Wikidata Contents 1 Structure 1 1 Development 2 Clinical significance 2 1 Injury 2 1 1 Treatment 3 Additional images 4 See also 5 ReferencesStructure EditThis section does not cite any sources Please help improve this section by adding citations to reliable sources Unsourced material may be challenged and removed May 2015 Learn how and when to remove this template message It is a broad flat membranous band situated slightly posterior on the medial side of the knee joint It is attached proximally to the medial epicondyle of the femur immediately below the adductor tubercle below to the medial condyle of the tibia and medial surface of its body 2 It resists forces that would push the knee medially which would otherwise produce valgus deformity It provides up to 78 of the restraining force that resists valgus inward pressing loads on the knee 3 The fibers of the posterior part of the ligament are short and incline backward as they descend they are inserted into the tibia above the groove for the semimembranosus muscle The anterior part of the ligament is a flattened band about 10 centimeters long which inclines forward as it descends It is inserted into the medial surface of the body of the tibia about 2 5 centimeters below the level of the condyle Crossing on top of the lower part of the MCL is the pes anserinus the joined tendons of the sartorius gracilis and semitendinosus muscles a bursa is interposed between the two The MCL s deep surface covers the inferior medial genicular vessels and nerve and the anterior portion of the tendon of the semimembranosus muscle with which it is connected by a few fibers it is intimately adherent to the medial meniscus 4 Development Edit Embryologically and phylogenically the ligament represents the distal portion of the tendon of adductor magnus muscle In lower animals adductor magnus inserts into the tibia Because of this the ligament occasionally contains muscle fibres This is an atavistic variation Clinical significance EditInjury Edit Main article Medial knee injuries An MCL injury can be very painful and is caused by a valgus stress to a slightly bent knee often when landing bending or on high impact It may be difficult to apply pressure on the injured leg for at least a few days It can be caused by a direct blow to lateral side of knee The most common knee structure damaged in skiing is the medial collateral ligament although the carve turn has diminished the incidence somewhat 5 MCL strains and tears are also fairly common in American football The center and the guards are the most common victims of this type of injury due to the grip trend on their cleats although sometimes it can be caused by a helmet striking the knee The number of football players who get this injury has increased in recent years Companies are currently trying to develop better cleats that will prevent the injury MCL is also crucially affected in breaststroke and many professional swimmers suffer from chronic MCL pains There are three distinct levels in a MCL injury Grade 1 is a minor sprain grade 2 in a major sprain or a minor tear and grade 3 is a major tear Based on the grade of the injury treatment options will vary 6 Treatment Edit Main article Medial knee injuries Depending on the grade of the injury the lowest grade grade 1 can take between 2 and 10 weeks for the injury to fully heal Recovery times for grades 2 and 3 can take several weeks to several months Treatment of a partial tear or stretch injury is usually conservative Most injuries that are partial and isolated can be treated without surgery 3 This includes measures to control inflammation as well as bracing Kannus has shown good clinical results with conservative care of grade II sprains but poor results in grade III sprains 7 As a result more severe grade III and IV injuries to the MCL that lead to ongoing instability may require arthroscopic surgery However the medical literature considers surgery for most MCL injuries to be controversial 8 Isolated MCL sprains are common citation needed Additional images Edit Anterior view of kneeSee also EditThis article uses anatomical terminology References Edit Wikimedia Commons has media related to Medial collateral ligament LaPrade R F Engebretsen A H Ly T V Johansen S Wentorf F A Engebretsen L 2007 The anatomy of the medial part of the knee J Bone Joint Surg Am 89 9 2000 2010 doi 10 2106 JBJS F 01176 PMID 17768198 S2CID 46253119 Gray s anatomy the anatomical basis of clinical practice Susan Standring Forty first ed Philadelphia 2016 ISBN 978 0 7020 5230 9 OCLC 920806541 a href Template Cite book html title Template Cite book cite book a CS1 maint others link a b Kovachevich Rudy Shah Jay P Arens Annie M Stuart Michael J Dahm Diane L Levy Bruce A 2009 05 07 Operative management of the medial collateral ligament in the multi ligament injured knee an evidence based systematic review Knee Surgery Sports Traumatology Arthroscopy 17 7 823 829 doi 10 1007 s00167 009 0810 4 ISSN 0942 2056 PMID 19421735 S2CID 22198296 Gray s anatomy the anatomical basis of clinical practice Susan Standring Forty first ed Philadelphia 2016 ISBN 978 0 7020 5230 9 OCLC 920806541 a href Template Cite book html title Template Cite book cite book a CS1 maint others link KNEE INJURIES www ski injury com Archived from the original on October 16 2013 Retrieved October 13 2013 unreliable medical source Medial Collateral Ligament Injury Grading Radiopaedia org Kannus P 1988 Long term results of conservatively treated medial collateral ligament injuries of the knee joint Clinical Orthopaedics and Related Research 226 226 103 12 doi 10 1097 00003086 198801000 00015 PMID 3335084 Indelicato P A 1995 Isolated Medial Collateral Ligament Injuries in the Knee The Journal of the American Academy of Orthopaedic Surgeons 3 1 9 14 doi 10 5435 00124635 199501000 00002 PMID 10790648 S2CID 2266550 Retrieved from https en wikipedia org w index php title Medial collateral ligament amp oldid 1151922704, wikipedia, 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