Coronary Ligament Injection

Indications and Clinical Considerations

The coronary ligaments, which are also known as the meniscotibial ligaments, are thin bands of fibrous tissue that anchor the medial meniscus to the tibial plateau and are extensions of the joint capsule ( Fig. 153.1 ). These ligaments are susceptible to disruption from trauma from forced rotation of the knee. The medial portion of the ligament is damaged most often ( Fig. 153.2 ). Patients with coronary ligament syndrome experience pain over the medial joint and increased pain on passive external rotation of the knee. Activity, especially involving flexion and external rotation of the knee, makes the pain worse; rest and heat provide some relief. The pain is constant and is characterized as aching and may interfere with sleep. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee, in particular the medial meniscus, may confuse the clinical picture after trauma to the knee joint.

Plain radiographs are indicated for all patients with coronary ligament syndrome pain. On the basis of the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging of the knee is indicated if internal derangement or occult mass or tumor is suspected as well as to confirm the diagnosis of coronary ligament syndrome ( Fig. 153.3 ). Bone scan may be useful for identifying occult stress fractures involving the joint, especially if trauma has occurred.