Definition: A lateral collateral ligament (LCL) sprain is an injury to the ligament on the outer surface of the knee joint.
The LCL connects the femur (thighbone) and the tibia, the outer bone of the two shinbones. It is a strong narrow rope of fibers that supports the outside of the knee, limiting sideways movement and keeping the outer surfaces of the joint in close proximity to each other. Of the four main ligaments that stabilize the knee, the LCL is the least likely to be injured but when it is, other ligaments are often damaged at the same time.
As with the other ligaments of the knee, sprains are graded according to the severity of the injury. Grade I: The ligament has been stretched, causing microscopic tears in the fibers, but the joint is still stable. Grade II: There is a partial tear in the ligament and mild to moderate instability in the joint. Grade III: The ligament has been completely torn, either in the middle of the ligament, or at the point of attachment to one of the bones and the joint is unstable.
Causes: An LCL sprain is usually caused by a direct blow to the inside of the knee that forces the joint outwards beyond its normal range of motion. It is a common injury amongst athletes, particularly those participating in football, soccer or wrestling. A sudden twisting motion can also induce a sprain.
Symptoms: Grade I sprain:
Mild tenderness on the outside of the knee over the LCL position
Very mild or no swelling
Some pain upon stressing of the joint
No looseness of the joint
Grade II sprain:
The area over the LCL is moderately tender
Some swelling
Pain upon stressing of the joint
Some looseness in the joint, but it cannot be completely bent sideways
Grade III sprain:
Variable pain which sometimes is less than with a grade II sprain, but can be very severe
Significant looseness in the joint
Knee feels extremely unstable and as though it will ‘give out’
Diagnosis: A thorough physical examination of the knee will be performed. The knees will be compared with each other and note taken of any differences in size and appearance. Observation and palpation (touch) of the knee will provide information on the extent of swelling, tenderness, bruising and any physical deformity.
You will be asked questions relating to the moment of injury; what type of movement or collision caused it; how rapidly any swelling appeared; if there was any popping sound heard at the time of injury; whether the knee feels unstable and if any weight can be placed upon it, and the severity of any pain being experienced.
If possible, your doctor will gently put stress on the ligament to evaluate the stability of the joint and to determine what movement or position causes pain. Swelling and pain may restrict the range of motion possible, but you might be asked to perform some motions to assist in the evaluation.
An x-ray might be taken to rule out a bone fracture, and an MRI taken to better view the soft tissues of the knee.
Treatment: For grade I and grade II LCL sprains, conservative treatment is the preferred option. The goal is to reduce pain and inflammation and then to restore full stability and mobility of the knee joint.
Refraining from any activities that cause pain will rest the ligament and allow it to begin healing. For grade II injuries, using crutches for a time will prevent weight being placed on the joint, and wearing a hinged knee brace will provide support and stability. Ice, crushed in a bag and wrapped in a towel, can be applied to the knee to help reduce inflammation and swelling. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen or aspirin, will also help reduce swelling and pain.
Following the acute phase of the injury, exercises to increase flexibility can begin. Other therapeutic measures might include ultrasound and massage. A gradual progression to strengthening exercises will be initiated and a return to full activity should be accomplished within 8 weeks.
Grade III sprains are often repaired by surgery. The torn ligament can either be stitched together or reconstructed using part of a tendon. Rehabilitation includes using a crutch and wearing a hinged knee brace, and a careful and graduated program of exercises. A return to full activity might take months to accomplish, but the prognosis is excellent as surgical repair of the LCL is highly successful.
Exercises: Do not undertake any exercise program after an LCL sprain without the permission of your doctor or physiotherapist.
Flex and extend: Sit on the edge of a table or stand and simply bend and straighten the knee as much as is possible without pain. Do not try to completely straighten the knee as this might stress the joint. Repeat 10-20 times for 1 set. Do 3 sets, 3 times a day. Heel slide: Lie on your back on the floor with your legs straight out in front on you and together. Slide the heel towards the buttocks as far as possible. Hold for 5 seconds then straighten. Knee flex: Standing, put the foot of the injured leg on a chair and slowly bend the knee forward as far as it will go. Hold for 10 seconds. Repeat 10 times. Hamstring flex: Sit on the floor with your legs straight out in front of you. Lean forward from the hips until a stretch is felt under the thighs. Hold 30 seconds. Repeat 2-3 times, 3 times a day. Quad stretch: Standing or lying down, hold the foot of the injured leg and draw it backwards towards the buttocks as far as possible until a stretch is felt in the front of the thigh. Hold 30 seconds. Repeat 2-3 times, 3 times a day.
Strength exercises: Quad contraction: Tighten the quadriceps muscles at the front of the thigh. Hold for 10 seconds then relax for 3 seconds. Do this 10-20 times. Straight leg raise: Sit on the floor with your legs straight out in front of you. Lift the injured leg up off the floor, keeping the knee straight. Hold for 10 seconds then relax for 3 seconds. Repeat 10-20 times. Calf raise: Stand with your feet shoulder width apart. Lift your heels off the floor as high as possible then slowly lower to the ground. Repeat 15-20 times for 1 set. Build up to 2-3 sets.
Prevention:
Warm up properly before exercise
Strengthen the leg muscles, particularly the quadriceps
Gradually increase the intensity of training
Wear correct footwear, including orthotics if necessary
Make sure any sporting equipment is properly fitted
Bracing: Wearing a knee brace may not be necessary for a mild sprain, but for more severe injuries it can provide support as the ligament heals and some protection from sideways force when you return to normal activities. Your doctor will advise you on the most appropriate brace, but you should make sure that it is properly fitted. It should not be uncomfortably tight, but your knee joint should feel secure and reinforced.
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