Ruptures of the medial collateral ligament (MKS) occur more frequently than ruptures of other ligaments of the knee joint. Their occurrence reaches 3 cases per 1000 people.
The ISS connects the inner epicondyle of the femur to the tibia, thus being the main obstacle to the external deviation of the tibia (hallux valgus). Deep portions of the ligament connect the medial meniscus to the femur, which leads to the possibility of combined damage to these structures.
Damage to the ISS occurs most often with an indirect mechanism of injury – excessive outward deviation of the shin and its external rotation. The force is transmitted to the fibers of the ligament and a rupture occurs, in most cases incomplete. Under the influence of a direct impact, an excessive tensile force is also applied to the external parts of the joint on the ISS and its complete rupture occurs. Cases of ruptures of the ISS in breaststroke swimmers are described: when kicking while swimming in this style, hallux valgus loads are constantly applied to the knee joint and the rupture occurs due to overuse syndrome.
During the injury, the patient feels a sharp pain, a click, a subcutaneous hemorrhage appears, and swelling in the projection of the ligament. With an isolated rupture due to the extraarticular location of the ligament, there is no pronounced hemarthrosis. Due to the pain syndrome, as well as the resulting instability, the patient spares the injured leg.
Examination reveals soreness on palpation in the projection of the ligament, subcutaneous hematoma, positive valgus test: increased deviation of the shin to the outside compared with the opposite side.
To exclude intra-articular fractures, radiography is performed in two projections. The degree of rupture of the ISS, as well as the presence of concomitant ruptures of the menisci and other ligaments, is determined using MRI.
The treatment tactics, even with a complete rupture of the ISS, are conservative in most cases: elastic bandaging, local cold, elevated limb position, limiting the load on the injured leg, wearing a brace with rigid side inserts for 3-4 weeks. During this period, most of the ISS ruptures heal.
In rare cases of old ungrown tears and pronounced instability in the joint, surgical treatment is used – plastic surgery of the medial collateral ligament with an autograft from the tendons of the muscles of the posterior surface of the thigh.
.webp)
.webp)
