Of all knee injuries, those to the medial side – the inside of the knee – are the most common. The medial ligament complex of the knee is composed of the superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL), and the posterior oblique ligament (POL). These ligaments have also been called the medial collateral ligament (MCL), tibial collateral ligament, mid-third capsular ligament, and oblique fibers of the sMCL, respectively. This complex is the major stabilizer of the medial knee. Injuries to the medial side of the knee are most commonly isolated to these ligaments. A thorough understanding of the anatomy and function of the medial knee structures, along with a detailed history and physical exam, are imperative to diagnosing and treating these injuries.
Structures on the medial side of the knee include the tibia, femur, vastus medialis obliquus muscle, semitendinosus tendon, gracilis tendon, sartorius tendon, adductor magnus tendon, medial head of the gastrocnemius muscle, semimembranosus tendon, medial meniscus, medial patellofemoral ligament (MPFL), sMCL, dMCL, and POL. It has been found that the most important structures for stabilization in this area of the knee are ligaments: sMCL, dMCL, and POL.
The bones of the knee are the femur, patella, tibia, and fibula. The fibula is on the lateral side of the knee and the patella has little effect on the medial side of the knee. The bony congruity of the medial knee consists of the opposing surfaces of the medial femoral condyle and the medial tibial plateau. On the medial femoral condyle there are three bony landmarks that are important: the medial epicondyle, adductor tubercle, and gastrocnemius tubercle. The medial epicondyle is the most distal and anterior prominence. The adductor tubercle is just proximal and posterior to the medial epicondyle. The gastrocnemius tubercle is just distal and posterior to the adductor tubercle.