Medial collateral ligament(deep fibres)

Findings

The pain may be sharp and intense, or constant, but is exacerbated by abduction and external rotation of the tibia. The pain is worse on turning over in bed, lying on the side with the bad knee uppermost, and by twisting and turning, including getting into a car and driving with the knee externally rotated. There is no swelling. There is often loss of some degree of flexion and it is sore to palpation over the mid to posterior medial joint line. Check for overpronation.

Cause

Strain or nipping, during external rotation and valgus forces, of the deep fibres of the medial collateral ligament that attach to the peripheral margins of the medial meniscus. The chronic strain is more common in mid- to old age.

Treatment

a)      Correct overpronation of the foot if it is present.

b)      Local cortisone injection to the tender area.

c)      Driving with the foot over the accelerator, and toeing into the brake, rather than with the foot covering the brake and toeing out to the acelarator. Getting in and out of a car with both legs together.

Sports

a)      This injury is often seen in a middle-aged person who has recently taken up running and has an overpronated foot.

b)      Anyone who runs with a “windmill” running style

c)      Breaststroke

d)     Golf – reverse pivot, with the left heel on the ground

e)      Soccer – tackling

Although painful, cortisone gives dramatic relief. An overpronated foot, if not corrected, will produce a reccurence. Fairly frequently the presentation has pain over the joint line that is more posterior than this lesion; it seems to settle with cortisone, but over a longer time, and there is no obvious meniscal damage.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English