The injury of the Lateral Collateral Ligament (LCL) is somewhat of a common occurrence that affects the functioning of the knee when it is torn. The LCL is positioned on the outer area of the knee joint, and its main purpose is to join the fibula to the femur, while preventing any widening to the outside portion of the knee.
Of the four ligaments in the knee, the LCL is considered to be one of the more important ligaments because it provides stability. This is achieved by preventing any excessive side to side movements or twisting. When any type of force to the knee causes excessive movement that is beyond what the ligament is able to withstand, the ligament can tear.
LCL Injury Incidence and Prevalence
Injuries to medical collateral ligaments and lateral collateral ligaments are common. Of the patients in the U.S. who present with acute knee injury in the emergency department, approximately 25 percent have some type of collateral ligament injury. Adults age 20 to 34 and age 55 to 64 have the highest incidence of LCL injury. This orthopedic mishap occurs equally in all races and both sexes.
Grades of LCL Tears
A tear to the LCL can range from a partial tear that results in minimal pain being felt, to a complete rupture that can result in disability and a significant amount of pain. There are three different grades that are used to classify the severity of an LCL injury.
These grades include:
- Grade I- Which is when a small amount of fibers are torn and results in minimal pain but still allows full functioning of the knee.
- Grade II- This is the result of a significant amount of fibers being torn and causes a moderate loss of knee functioning.
- Grade III- This is when all the fibers are ruptured and results in knee instability, as well as a significant loss of the knees functions. This can also cause injuries to other structures like the cruciate or menisci ligaments.
Mild to Moderate LCL Injuries
In many cases, an injury will occur during strenuous activity when excessive strain is put on the LCL. This could be from a sudden shift in movement that could put to much weight on the knee or extend it too far. When minor injuries to the LCL are present, the patient may continue their regular activity, but experience swelling, stiffness, or a gradual increase in pain that is usually localized to the outer portion of the knee.
With minor injuries to the LCL, such as with a grade I or grade II injury, the ligaments are not completely torn and will generally be treated by utilizing the non-operative technique. This type of treatment will focus on resting the knee, compression, cryotherapy, and keeping it compressed throughout the acute phase.
The main goal with an injured LCL is to reduce the pain as much as possible and to keep the swelling down. During this time, the patient is required to wear a hinged knee brace that protects the knee from experiencing any additional stress or injury. They can put weight on the injured knee, but it is recommended to keep it in moderation to prevent any additional aggravation.
Throughout the early stages of an LCL injury the patient is introduced to active range of motion exercises to prevent the joint from becoming stiff, and to help strengthen the ligament. Recovery time for a minor LCL injury can generally take around six weeks, and when the injured knee has healed to a level that is comparable to the uninjured knee, normal activity can be resumed.
Severe LCL Injury Treatment
A more severe injury to the LCL that results in a complete tear and causes instability will require a reconstruction or surgical repair to be performed. If the ligament is torn from the lower or upper attachment, then a repair will usually be performed.
However, if the tear has occurred in the middle of the ligament, or it is more than three weeks old, a reconstruction is needed, which consists of a tendon graft. The reconstruction of a ligament involves a rebuilding procedure with tissue that replaces the damaged ligament. The tissue used in this procedure is either taken from the patient’s body or it comes from a donor. The two most common areas that tissue is taken from is the hamstring tendon or the knee cap.
Most LCL repair procedures are performed by a knee arthroscopy, which inserts a small camera into the surgical cut of the knee. This allows the knee surgeon in Phoenix to check the surrounding tissues and ligaments of the knee, and to make any necessary repairs. Additional incisions are then made, and with the use of special surgical instruments, the torn ligament is removed. If the patient’s own tissue is being used in the procedure, a larger incision is made to remove the tissue.
The Phoenix sports medicine surgeon will then form tunnels in the bone that the new tissue is fed through, and is positioned in the same area as the old ligament. In order to hold the new ligament in place screws or other types of devices are used. As the area heals, the bone tunnels will fill in and secure the new ligament in place.
Following the reconstruction procedure, the knee is kept in a brace for around six to eight weeks. A rehabilitation program is started following the procedure to help regain strength and motion. In most cases, the patient is able to return to regular activities within four to six weeks following reconstruction.
Dr. Sumit Dewanjee with FXRX is the top sports medicine surgeon in Phoenix and Scottsdale. He offers expert knee treatments including minimally invasive ligament repair. For 5 straight years, he has received the Patients Choice Award as a top orthopedic doctor in Phoenix.
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