Pediatric and Adolescent Medial Collateral Ligament Injuries

Abstract

Frequently overlooked, medial collateral ligament (MCL) injuries constitute a high percentage of sports-related injuries in pediatric and adolescent patients, and a nuanced approach is required to optimize outcomes in this unique patient population. We present a current concept review on MCL injuries to better define anatomic, clinical, and treatment applications unique to the pediatric and adolescent patient. Injury assessment in this age group must include a comprehensive knee exam evaluating for associated injuries unique to developing patients. Imaging can include a four-view knee series, stress radiographs, and alignment films to guide and follow treatment. To optimize patient outcomes, a detailed understanding of patient-specific factors related to knee anatomy and biomechanics during development are essential, along with appropriate characterization and classification of injury severity. The majority of MCL injuries in this age group can be managed nonsurgically with a thoughtful approach to rehabilitation, based on clinical and radiographic assessment. Some injuries may benefit from surgical intervention, such as primary repair versus reconstruction. The goal of this is to restore normal mechanics without compromising growth and development. Key Concepts • The superficial MCL is the main stabilizer of the medial aspect of the knee from valgus load and helps protect the Anterior Cruciate Ligament (ACL) from rupture or re-tear. • Nonoperative treatment with bracing, activity modifications, and a formal physical therapy program is the first line of treatment for skeletally immature patients. • Valgus stress radiographs are the preferred method of diagnosing an MCL tear that may be resistant to nonoperative intervention and require operative treatment. • Operative treatment with reconstruction is recommended over repair for persistent medial instability or gapping >3mm seen on stress radiographs after 4-6 weeks of nonoperative treatment. • Reconstruction is currently recommended with all epiphyseal femoral tunnel and physeal spanning tibial reconstruction to recreate the anatomic landmarks of the superficial MCL.