LCL Knee Ligament Injury Explained
The Lateral Collateral Ligament is the knee ligament that is located on the outside of the knee that links the thigh bone and the shin bone. It is the main stabiliser of the lateral aspect of the knee. A ligament injury is referred to as a sprain, and this knee injury can occur if the knee is twisted or subject to force from an opponent during sport. Sometimes if individuals are particular bow-legged (varus) they can be more susceptible to strain on the LCL.
Depending on the severity of the injury it is classified as first, second or third degree:
- A first degree sprain is damage to only a few ligament fibres.
- A second degree sprain is damage to a more extensive number of ligament fibres, but the ligament remains intact.
- A third degree sprain is a complete rupture of the ligament.
The injury is less common than damage to the Medial Ligament but, in collision sports such as rugby and football, the Lateral Ligament can be damaged when an opponent applies a force (such as a kick) to the inside aspect of the leg just below the knee.
A moderate impact against the inner side of the knee joint can cause the Lateral Collateral Ligament to rupture. A more violent impact causes the Anterior Cruciate Ligament to rupture as well. In severe cases the Posterior Cruciate Ligament also ruptures.
LCL Knee Ligament Injury Signs & Symptoms
With a first degree sprain of the Lateral ligament there will be pain when the site of the damage is touched. Stressing the ligament (when the knee is slightly bent and the shin is moved inwards in relation to the thigh) is painful – this action is reproduced when standing up from sitting in a chair.
In the case of a second degree sprain, the pain is more severe when the injury site is touched and when the ligament is stressed. Because the ligament is outside the knee joint, there may not be marked swelling of the knee. There may be pain present around the back of the knee where the ligament also has attachments into the muscles such as the Popliteus.
In the case of a third degree sprain, where the ligament is ruptured, the pain is excruciating and the knee joint becomes unstable.
LCL Knee Ligament Injury Treatment
In the early stage of all three levels of injury, medication prescribed by a doctor for pain relief should be taken if necessary. The PRICE protocol should be followed – Protection, Rest, Ice, Compression and Elevation (never apply ice directly to the skin). The knee should be rested in an elevated position and Cohesive Bandage (which sticks to itself) should be used as a compression bandage to help prevent excessive swelling. A Knee Brace can be helpful to protect the knee and provide reassurance.
Ice Packs applied for 20 minutes every 2 hours can aid pain relief and help to prevent more tissue damage by cooling the tissues. The Ice Packs relieve pain and reduce bleeding within the tissue. The Aircast Knee Cryo/Cuff is the most effective method of providing ice therapy and can be used for the home treatment of knee injuries and knee pain. It can provide continuous ice cold water and compression for 6 hours to significantly reduce knee pain and knee swelling.
In the case of a first degree sprain, sporting activities should not be undertaken for about 3 weeks, until symptoms have resolved and some strength regained.
For second-degree sprains, the rehabilitation period will be between 6 and 8 weeks. Rehabilitation under the supervision of a chartered physiotherapist is desirable to prevent a recurrence of the injury, which can be common if a return to sport is attempted too early. Running in a swimming pool, using a Buoyancy Aid, is an ideal method of maintaining fitness while the ligament is healing. Strengthening at both the ankle and hip, using a wobble board or resistance bands can also be beneficial in restoring stability before returning to sport.
In the case of a third degree sprain, where the ligament is completely ruptured, the treatment of choice is surgery to repair the structure. The type of reconstruction used will depend on the exact site of the damage and the preference of the surgeon.
LCL Knee Ligament Injury Prevention
What you can do
|Wear a knee brace for support & protection|
|Use a Wobble Board to improve proprioception|
In the case of someone who has had a previous lateral ligament injury there may be a slight weakness, but there are measures that can be taken to help prevent a recurrence. A Knee Brace can provide increased knee stability and reassurance following previous knee injuries, especially during activities such as skiing.
Following a rehabilitation programme under the supervision of a chartered physiotherapist will help. This should include a lot of proprioception exercises (these improve the stimuli within the body relating to position and movement), since proprioceptive ability will be affected by the damage to the ligament. A Wobble Board is an excellent tool for continuing proprioception exercises at home.
Here we present a rehabilitation programme for a professional footballer with a grade II lateral collateral knee ligament sprain.
|Days 1 to 3
Acute PhaseRest from activity.Protect the injury site from further damage by using crutches to avoid putting any weight through the injured leg.Apply ice packs or a ‘cryo-cuff’ device for 10 minutes every 2 hours (never apply ice directly to the skin). This will have a pain-relieving effect and also help to control the swelling. Apply a compression bandage to limit the joint swelling. The injured knee should be elevated in order to control and reduce swelling. Oral anti-inflammatory medication may be prescribed by a doctor.Days 4 to 14
Sub-acute PhaseContinue to rest the injured part completely.Continue to protect the injured knee from further damage by using crutches. If it is not too painful it may be possible to begin partial weight-bearing on the affected leg whilst continuing to use the crutches. To further protect the knee a hinged knee brace should be used to prevent stress on the lateral ligament. This should be locked between minus 10 degrees of extension and 90 degrees of flexion.Once the inflammatory response from the damaged tissue has settled (after 3-5 days) the ligament begins to lay down scar tissue to repair itself. It is thought that this process can be encouraged with the use of electrotherapy treatments such as ultrasound and pulsed short-wave diathermy.Begin ankle and hip range-of-movement exercises.Weeks 2 to 4
PhaseThe hinged knee brace should be worn at all times during the early active rehabilitation phase, and should be set between minus 5 degrees of extension and 110 degrees of flexion. Provided it is not too painful, full weight-bearing should be encouraged and the crutches should be abandoned.A normal gait pattern should be present, with the heel striking the ground first and the toes pushing off for the next step.Isometric quadriceps should be performed in the pain-free range of movement. Straight leg raising should be performed to reinforce quads contractions.Gentle range-of-movement exercises should be encouraged between 90 and 30 degrees of knee flexion.Early proprioception exercises should be initiated.Weeks 4 to 6
PhaseThe hinged knee brace should be worn at all times during the active rehabilitation phase. There should be no restriction of knee extension or flexion.Range-of-movement exercises should be continued.When range of movement allows, static cycling should be initiated.Isotonic muscle strengthening exercises should be initiated and resistance gradually increased (leg press/squats/hamstring curls/quads extensions).Continue proprioceptive training.Weeks 6 to 10
PhaseThe hinged knee brace should continue to be worn, without restriction of knee extension or flexion.Range-of-movement exercises should be continued, until full range of extension and flexion is pain free.Isotonic muscle strengthening should continue, so that the affected knee’s quads and hamstrings have 90% strength of the unaffected knee.Continue static cycling and increase resistance.Initiate straight line running, gradually increasing the pace. Initiate ‘figure-of-eight’ running, gradually increasing turns.Begin ‘fitter’ exercises.Weeks 10+
PhaseThe hinged knee brace should be discarded.Isotonic muscle strengthening should continue.Continue to progress static cycling.Increase speed of running and increase turning angle to 180 degrees.Begin cliniband lateral agility/running exercises and star jumps. Hop distance should be 100% of opposite knee. Kicking the ball/block tackling.