Injury Patterns of the Deep Medial Collateral Ligament of the Knee in Children: A Retrospective Cross-sectional Study

Purpose or Learning Objective: To investigate the epidemiology and morphological patterns of deep medial collateral ligament (dMCL) injuries in pediatric patients.

Methods or Background: Patients < 18 years of age who underwent standard knee magnetic resonance imaging (MRI) between January 1, 2021, and February 24, 2023, at Heim Pál National Pediatric Institute, Budapest, Hungary, were collected retrospectively. All patients were scanned on a 3-T MRI machine with a dedicated eight-channel knee coil. The studies performed with a nonstandard knee MRI protocol were excluded. Two board-certified musculoskeletal radiologists with 2 and 3 years of experience, respectively, evaluated the knee studies for dMCL injuries. Demographic data, laterality of the injuries, patency of the physis (open, fusing, or closed), and type of dMCL injuries were assessed. All injuries were classified as either attachment site avulsion injuries or intraligamentous lesions. Avulsion fractures were subgrouped into simple (only perichondrial) and complex (perichondrial and cartilage/bone) avulsions. Intraligamentous injuries were subgrouped into partial- or full-thickness lesions. Inter-reader agreement was also evaluated.

Results or Findings: A total of 992 studies were reviewed, of which 92 patients had a dMCL injury (69 intraligamentous and 23 avulsion-type injuries). We identified 55 boys and 37 girls. There was no significant difference in age between boys and girls (mean ± standard deviation: 13.7 ± 2.89 versus 14.2 ± 2.75; P = 0.402). Similarly, no difference was detected in the type of injury between boys and girls (P = 0.269). Between avulsion versus intraligamentous injury, age showed a significant difference (11.3 ± 3.24 versus 14.67 ± 2.09; P < 0.0001). Patients with an avulsion-type injury were significantly younger. The chi-square test detected no significant difference between the type of injury and the laterality (P = 0.698); however, there was a significant difference between the type of injury and the patency of the physis (P < 0.0001). In univariate logistic regression analysis, only age proved to be a significant predictor for the type of injury (odds ratio: 0.6255; 95% confidence interval, 0.4885–0.7650; P < 0.0001). The inter-reader agreement on the injury patterns was good (κ = 0.8).

Conclusion: Our study showed that dMCL injuries are commonly seen in routine knee MRI studies. Their morphological patterns indicate a strong relationship with the age of the patient.

 

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Artikel online veröffentlicht:
26. Mai 2023