Lateral Collateral Ligament (LCL) Tears
The lateral collateral ligaments are a primary knee stabilizers that limit excessive side-to- side movement of the knee. They are located on the outer sides of the knee and connects the thigh bone to the fibula – the smaller of the two lower leg bones. An LCL tear may be a sprain or a rupture of the ligament. LCL tears rarely occur in isolation. They are usually associated with injuries to other knee ligaments.
Diagnosis can be challenging when the LCL is involved in multiligament injuries. Failure to identify LCL injuries in this context can result in knee instability and unsatisfactory outcomes after cruciate ligament reconstruction. Nonsurgical treatment, repair and reconstruction surgery can all be used to manage LCL injury. The optimal treatment is determined based on the severity of the injury.
The LCL is often called the posterolateral corner (PLC). Injury to the LCL is associated with nerve injury.
- A grade 1 tear is a mild injury that causes only microscopic tears in the ligament. The ligament remains intact and can still function.
- A grade 2 tear is a moderate injury that causes partial tearing of the ligament. There is some loss of function.
- A grade 3 tear is a severe injury that causes a complete rupture of the ligament. This type of tear makes the knee joint unstable.
LCL tears usually occur due to a direct force that pushes the knee sideways, such as:
- A direct blow to the inside of the knee, which pushes the knee outwards (varus force).
- A hyperextension injury, where the knee is straightened more than its normal full straight position.
- A severe twisting injury.
Common symptoms of an LCL tear include:
- Pain and tenderness along the outside of the knee.
- Swelling and bruising.
- Stiffness and decreased motion of the knee.
- Instability, or a feeling that the knee may give way under stress.
Dr. Masi Reynolds will review your medical history and the history of your knee injury. He will perform a physical examination checking for tenderness, swelling and knee stability. He will order X-rays to rule out broken bones and an MRI to visualize the soft tissues including the ligaments, meniscus and cartilage.
Treatment options depend on the severity of the tear adn whether other knee structures are also injured. Here are the general guidelines:
Grade 1 & Grade 2 Tears – typically treated conservatively:
- Rest, Ice, Compression, and Elevation (RICE protocol) to reduce pain and swelling.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce pain and inflammation.
- Bracing or taping to stabilize the knee and protect the ligament while it heals.
- Physical therapy exercises to strengthen the muscles around the knee and restore range of motion.
Grade 3 Tears:
Severe, complete LCL tears often require surgical repair or reconstruction, especially if other structures in the knee are injured (like a combined injury with the ACL, PCL, or MCL). Reconstruction requires a graft of a tendon often from the hamstrings. Post-surgical rehabilitation is crucial and includes physical therapy exercises to regain strength and movement.
The time it takes to recover from an LCL tear varies:
- Grade 1 and Grade 2 tears generally heal with conservative treatment within a few weeks to a few months.
- Grade 3 tears, especially those requiring surgery, often require a longer recovery time, which can be several months. A knee brace is required after surgery. Full range of motion is permitted but weight bearing is delayed until six weeks after surgery. Strengthening of hamstrings and quadriceps continues for another six weeks. At 12 weeks after surgery the brace is removed, and full weight bearing is permitted. Return to unrestricted activities may be permitted at six months postoperatively.
Isolate LCL ligament injuries are rare in this population. Grade III injuries represent 20-25% of collateral ligament injuries and most occurred during football or soccer