Case 4: A 17-year-old football running back injured his knee in Friday's football game. An opponent came from the side and fell into his knee as he was being tackled. He had immediate pain on the inside of the knee and was unable to continue playing. He has pain with full knee extension and flexion and has a knee effusion. He has discomfort and instability noted with valgus stress testing of the knee at 30°.
The MCL, a medial stabilizer of the knee, is injured after a valgus stress is placed to the knee, such as being tackled during football. There is usually a moderate effusion, pain, and decreased knee range of motion. Tenderness to palpation is present over the MCL and pain or instability is present with a valgus stress to the knee at 0 or 30°. In skeletally immature adolescents, the tibial or femoral physis may be damaged by the same mechanism that damages the MCL. These adolescents will have pain with palpation over the physis as opposed to the ligament. Stress radiographs can
be helpful in determining a physeal injury. MCL injuries are usually treated with immobilization in a straight leg brace for 2-3 weeks to allow the ligament to heal, followed by aggressive physical therapy to return them to their sport.
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