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Abstract
The SMCL is long, well delinated structure originating on medial epicondyle and inserting 7 to 10cm below the joint line on the posterior half of the medial surface of the tibial metaphysis deep to pes anserinus tendons. The deep MCL passes to articular margin of the medial condyle of the tibia and is fused with the medial meniscus. Histologically, the MCL consist of fibroblasts surrounded by aggregates of collagen, elastin, proteoglycans, glycolipids and water.
The biomechanical studies of the MCL showed that, the superficial MCL provided 57 percent of the restraining valgus moment at five degrees of knee flexion, and provided 78 percent of the moment at 25 degrees of knee flexion. Pathologically, normal MCL is composed of dense, relatively acellular and regular collagen tissue. Ligaments encounter loads in everyday activities, as they transmit forces from bones to the skeleton. Forces parallel to the cross-section can create shear loads and result in ligament strains. After injury of a tendon, a process of healing and scar formation is initiated that can be subdivided into several stages, the first inflammatory phase, the next proliferation/fibroplasia stage, and the third remodeling/maturation stage. The primary mechanism of injury to the MCL is most commonly a valgus force. This occurs with a lateral force to the side of the distal femur with the foot being fixed to the ground.
In medial side complex chronic injury, the patient will report medial knee pain and valgus instability.