Tears in the distal superficial medial collateral ligament: the wave sign and other associated MRI findings
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SCIENTIFIC ARTICLE
Tears in the distal superficial medial collateral ligament: the wave sign and other associated MRI findings Robert D. Boutin 1
&
Russell C. Fritz 2 & Richard E. A. Walker 3 & Mini N. Pathria 4 & Richard A. Marder 5 & Lawrence Yao 6
Received: 4 September 2019 / Revised: 13 November 2019 / Accepted: 14 November 2019 # ISS 2019
Abstract Objective To analyze the MRI characteristics of distal superficial medial collateral ligament (sMCL) tears and to identify features of tears displaced superficial to the pes anserinus (Stener-like lesion (SLL)). Materials and methods Knee MRI examinations at four institutions were selected which showed tears of the sMCL located distal to the joint line. MRIs were evaluated for a SLL, a wavy contour to the sMCL, and the location of the proximal sMCL stump. Additional coexistent knee injuries were recorded. Results The study included 51 patients (mean age, 28 years [sd, 12]). A SLL was identified in 20 of 51 cases. The proximal stump margin was located significantly (p < 0.01) more distal and more medial with a SLL (mean = 33 mm [sd = 11 mm] and mean = 6.5 mm [sd = 2.5 mm], respectively), than without a SLL (mean = 19 mm [sd = 16 mm] and mean = 4.8 mm [sd = 2.4 mm], respectively). Medial compartment osseous injury was significantly (p < 0.05) more common with a SLL (75%) than without a SLL (42%). The frequency of concomitant injuries in the group (ACL tear, 82%; PCL tear, 22%; deep MCL tear, 61%; lateral compartment osseous injury, 94%) did not differ significantly between patients with and without a SLL. Conclusion A distal sMCL tear should be considered when MRI depicts a wavy appearance of the sMCL. Distal sMCL tears have a frequent association with concomitant knee injuries, especially ACL tears and lateral femorotibial osseous injuries. A SLL is particularly important to recognize because of implications for treatment. Keywords Medial collateral ligament tear . Pes anserinus . Knee . MRI . Trauma
Introduction The superficial medial collateral ligament (sMCL) is the largest ligament at the medial aspect of the knee [1] and is the
* Robert D. Boutin [email protected]
primary static stabilizer against valgus stress [2, 3]. The sMCL and other medial knee stabilizers (i.e., the deep medial collateral ligament and the posterior oblique ligament) are often reported as the most commonly injured ligamentous structures
1
Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5105, USA
2
Musculoskeletal Radiologist, National Orthopedic Imaging Associates, 1260 South Eliseo Drive, Greenbrae, Greenbrae, CA 94904, USA
3
Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone & Joint Health, University of Calgary, Room 812, North Tower, Foothills Medical Centre, 1403-29th Street NW, Calgary, AB T2N 2T9, Canada
4
Department of Radiology, University of California San Diego Health System, 200 West Arbor Drive, San Diego, CA 92103-8756, USA
5
Department of Orthopaedic Surgery, UC Davis School
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