What are Lateral Collateral Ligament Injury Symptoms that need Surgery?

Lateral collateral ligament (LCL) injury often requires reconstructive surgery. LCL reconstruction is necessary to avoid rotational instability of the knee and cartilage damage. The extent of damage can affect the outcome of surgery. Certain symptoms exist that make surgery necessary. Our orthopedic surgeons are able to reattach the ligament with sutures or reconstruct it using donor tissue.

The lateral collateral ligament is one of the four major ligaments of the knee. The LCL is outside of the knee, and it connects the femur (thigh bone) to the fibula (lower leg bone). The LCL’s main function is to avoid varus stress across the knee (buckling outward). Together with the popliteofibular ligament, the joint capsule, and the popliteus tendon, these structures form the PLC complex, which gives you external rotational stability.

LCL Injury and Symptoms

Lateral collateral ligament injury symptoms vary from person-to-person. Injuries to the LCL and posterior lateral corner occur from a rotational force across the knee. A contact injury is a direct blow to the inside of the knee, whereas a non-contact injury is caused from hyperextension stress. The symptoms of LCL injury include:

• Swelling and tenderness along the outside of the knee
• Pain that can be mild to moderate
• Feeling that the knee will give way under stress
• Numbness or weakness of the foot related to the peroneal nerve, which is near the ligament stretched during injury

Can you Walk with a Torn LCL?

A torn lateral collateral ligament can produce severe pain and limit movement, depending on the severity of the injury. However, some people can walk following an injury or tear to the LCL. The doctor will grade the tear based on symptoms. A careful eye is needed to diagnose a posterolateral and lateral injury. The doctor will check for:

• Ecchymosis and skin abrasions on the side of injury
• Pain on palpation
• Difficulty ambulating
• Loss of normal knee movement

Diagnosis and grading of the tear are confirmed using a magnetic resonance imaging (MRI) scan. An MRI has a 90% accuracy for showing tears of the posterolateral corner and ligaments. To isolate the LCL, the doctor will apply stress during flexion and compare the knee to the other one. Signs that the knee requires surgery include a positive prone “dial” sign, problems with foot eversion and inversion, and severe tearing found during arthroscopy.

LCL Surgery for Tears and Injury

The lateral collateral ligament does not heal as well as the medial collateral ligament. For a minor tear, non-surgical treatment is used (bracing, rest, and ice). For high-grade acute tears, the ligament must be surgically reattached to the femur or fibula, depending on the situation. Surgical management includes open reconstruction using an allograft (donor material) or autograft (from the patient). The mini-open surgery involves a tiny incision and use of special tools and a camera to repair the ligament. The ends can be sewed together in certain cases where the ligament is torn into two pieces.

For a ruptured ligament, the surgeon will evaluate the situ1ation and make a surgical plan. Be sure to discuss all options with the orthopedic specialist and inquire about alternative therapies. When surgery is required, expect to have 4-12 weeks of recovery, which involves working with a physical therapist to regain strength and function of the knee.

Resources

King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees. Arthroscopy. 2016 Sep;32(9):1814-9. 

Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci. 2016 Nov 19. pii: S0949-2658(16)30217-2. doi: 10.1016/j.jos.2016.10.009.