Medical Collateral Ligament Injection

Acute or chronic sprain

Causes and findings:
• Trauma - typically flexion, valgus and lateral rotation of the knee as in a fall while skiing
• Pain at medial joint line of knee
• Painful: passive valgus passive lateral rotation of the knee

Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1 ml 2%
Total volume - 1.5 ml

Anatomy:
The medial collateral ligament of the knee passes distally from the medial condyle of the femur to the medial aspect of the shaft of the tibia and is approximately a hand's width long and a good two fingers wide at the joint line. It is difficult to palpate the ligament as it is so thin and is part of the joint capsule. It is usually sprained at the joint line.

Technique:
• Patient lies with knee supported and slightly flexed
• Identify and mark medial joint line and tender area of ligament
• Insert needle at mid-point of tender area. Do not penetrate right through joint capsule
• Pepper solution along width of ligament in two rows

Aftercare:
Gentle passive and active movement within the pain-free range is started immediately.

Comments:
Occasionally the distal or proximal end of the ligament is affected, so the solution should be deposited there.

Alternative approaches:
Sprain of this ligament rarely needs to be injected, as early physiotherapeutic treatment with ice, massage and mobilization is very effective. The injection approach can be used when this treatment is not available or the patient is in a great deal of pain.