Lateral Collateral Ligament Injury of the Knee

What is Lateral Collateral Ligament or LCL injury?

The Lateral Collateral Ligament (LCL) is found on the outer side of the knee. The knee joint is the single largest joint in the body and is prone to injury. It functions as a knee joint stabilizer with the primary function being to prevent excessive rotation of the knee. 

Lateral Collateral Ligament injuries are less frequent than other ligament injuries. The causation of the LCL injury is when the knee experiences a sudden heavy force that extends it to its extremities. This injury frequently occurs in high-intensity sports with jumping and landing such as cricket, wrestling, football, skiing, or basketball.  

An LCL injury is categorized in grades depending upon the intensity of the injury: 

Grade 1:  

The sprain is causing mild to moderate pain. The intensity of injury is mild and there’s a slight decrease in the knee’s range of motion. The knee is still in a stable condition and is functional. 

Grade 2: 

Partial tear with high-intensity pain. The ligament is stretched to its extreme and loses its elasticity. Movement ranges from moderately to highly decreased.

Grade 3: 

Complete ligament tear with high-intensity pain. The knee is no longer functional and the joint is not stable. The range of motion is severely affected. 

Lateral Collateral Ligament or LCL injury Causes

The knee joint is highly prone to injury in case of sudden impact, a few causes of the injury are: 

  • A blow to the medial knee. The sudden force’s impact on the LCL will cause it to stretch or tear. The LCL injury is witnessed frequently among athletes in sports like American football or hockey because of the collision of players with each other. 
  • Sudden change in direction or turning on one foot. Fast-paced sports where athletes make sharp turns or stop like soccer. Wrestlers too are prone to injury because of the sudden movements they make. 
  • Bad landing or awkward jump. In the game of cricket, while landing from a jump if a bowler is not landing properly on his front leg properly, the sudden impact of the body’s weight might have an impact on the knee causing it to bend in an awkward position or stretch it far and cause a tear in the ligament. Other sports where the same is liable are basketball and volleyball. 

Lateral Collateral Ligament or LCL injury Symptoms

Symptoms and intensity of pain can vary according to the grade of the LCL injury. These symptoms include: 

Grade 1: Mild Sprain

  • Mid intensity pain and tenderness on the affected ligament
  • The majority of the time there’s no swelling
  • Mild restriction in movement of the joint
  • Stable and functional knee with no major affected movement

Grade 2: Partial Tear of Ligament 

  • Mild or high intensity of pain in the knee
  • Significant swelling at the ligament 
  • Discoloration on or around the knee
  • Bruises on the outer area of the knee
  • Restriction in the movement of the knee

Grade 3: Complete Tear of Ligament

  • High-intensity pain, can also 
  • Locking of joints when walking or trying to stand
  • Significant swelling
  • Instability while walking or standing 
  • Feeling numbness or weakness in feet 
  • Feeling stiff, sore, or tenderness on the outer area of the knee

Lateral Collateral Ligament or LCL injury Diagnosis

Physical Examination: 

Dring examination doctor investigates the swelling, and bruises at the joint. Range of motion exercises are done alongside muscle strength, sensation, reflexes, and palpitation is checked. Press is put on the side of the knee when the leg is bent and straight. Analysis and tests are done to classify the severity of the injury. 

X-ray/Radiographs: 

Radiographs of AP and Lateral radiographs are done to check for associated injuries. Varus and Posterior kneeling stress images are used to determine the severity of LCL and PLC injuries.

Magnetic Resonance Imaging (MRI): 

It is considered the most efficient test for diagnosing LCL injuries. This LCL injury test has a 90% sensitivity and specificity rate for detecting it. 

Ultrasound: 

The most effective tool for a rapid diagnosis of LCL injury. A thickened and hypoechoic LCL indicated the presence of an LCL injury. An ultrasound may display increased edema,  a lack of fiber continuity, and dynamic laxity of the LCL in case of a complete tear. 

Lateral Collateral Ligament or LCL injury Treatment with Physical Therapy

Rest: 

Rest is of utmost importance during recovery. Consistent use of the ligament and stressing it when injured may cause severe damage. Bracing the knee for a few days will also advance the healing. 

Elevation: 

Elevation of the joint will ease the blood circulation and help drain the toxic substances as the injured tissue is broken down for healing. 

Cryotherapy and Compression: 

Immediately apply ice to the injured area for 15 to 20 minutes every hour. It’ll help reduce the inflammation and swelling of the joint. 

Post cryotherapy, a compression sleeve/bandage must be wrapped to limit the swelling and protect the knee. 

Exercises: 

Range of motion exercises will help in building strength and stability to help restore normal function. These began with the physiotherapist after the pain had settled. 

Additionally, stretching exercises, progressive resistive exercises (PRE), balance exercises, and plyometrics will be taught under the guidance of the physiotherapist. 

Cautionary Advice for Lateral Collateral Ligament or LCL injury

Rest is important for quicker recovery. Strengthening exercises must be done to prevent further injuries. Set of exercises taught by the physiotherapist must be followed with a strict schedule and additional exercises not assigned are to be avoided. The exercises must only begin when the pain is eliminated. Supportive gear can be worn during activities such as a knee brace. The injury can be caused due to multiple reasons. It is to be noted that additional structural injuries can be caused by an LCL injury. For a grade 3 tear, surgery may be required to restructure the joint and stabilize the knee.