Abstract
Medial collateral ligament (MCL) injuries are the most frequent ligamentous injuries of the knee. Focused extracorporeal shock wave therapy (f-ESWT) is progressively expanding its field of application to many musculoskeletal pathologies. Although there is evidence surrounding the efficacy of f-ESWT in tendinopathies, no studies have described the usefulness of ultrasound (US)-guided f-ESWT in the treatment of ligament injuries. Herein, we report a case of a MCL injury treated with f-ESWT. Moreover, our case shows the importance of using ultrasonography in determining the effect of treatment. A 60-year-old man with a focal area of lesion in the deep fibers underwent 4 weekly sessions of US-guided f-ESWT to the injured ligament area. His pain decreased to a visual analog scale (VAS) of 3 at the end of the treatment and was completely resolved at the 1-month follow-up visit, with these results being maintained at 4-month follow-up. The US examination showed an initial deposition of “newly formed tissue” at the site of previous injury of the proximal MCL insertion, and a reduction in MCL thickness together with an improvement in echostructure. Based on this result, we speculate that non-surgical ligament injuries could be a new indication for f-ESWT. However, further investigation on the effects of f-ESWT for ligament injuries is needed.
Highlights
The medial collateral ligament (MCL) is a very complex apparatus connecting the medial surface of the femoral condyle to the tibia
The knee pain of patient slowly decreased during the 4 weeks after starting extracorporeal shockwave therapy (ESWT), with a visual analog scale (VAS) score of 3, at the last treatment session
Patient reported a complete resolution of knee pain (VAS 0)
Summary
The medial collateral ligament (MCL) is a very complex apparatus connecting the medial surface of the femoral condyle to the tibia. The primary mechanism of injury to the MCL results from a valgus force with the foot being fixed to the ground [3]. The severity of the damage can be subdivided into three grades, depending on the state of laxity highlighted by the valgus stress test at 30◦ knee flexion [4]: 3–5 mm (grade 1), 6–10 mm (grade 2), and >10 mm (grade 3). A further classification from the American Medical Association subdivided the MCL injuries into three grades based on the severity of ligament damage: grade I with minimal torn fibers without loss of integrity, grade II with a partial MCL tear, and grade III with disruption of the ligament [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
