Lateral Collateral Ligament (LCL) Injury

The Lateral Collateral Ligament (LCL) is on the outer side of the knee connecting the lower leg bone (the fibula) to the thigh bone thighbone (the femur). The primary function of the LCL is to provide stability to the knee by preventing excessive side-to-side movement, especially when the knee is subjected to being pushed inward from the outer side (varus stress). The LCL works with other knee structures to maintain proper alignment and ensure smooth, stable movements during activities such as walking, running, and lateral motions. Injury to the LCL results in instability and pain on the outer side of the knee, often caused by direct trauma or a force that pushes the knee inward.

Cuban orthopedic surgeons are highly experienced in accurately assessing the extent of LCL injuries and providing the most effective treatment plans. For this knee condition, treatment options in Cuba may include non-surgical methods such as physical therapy to strengthen the surrounding muscles and improve stability, or surgical reconstruction to repair or replace the torn ligament.

When LCL is left untreated, several complications may develop, including:

• Chronic instability of the knee.
• Higher risk of falls and further injuries.
• Persistent or worsening pain.
• Swelling and inflammation.
• Loss of knee function.
• Potential for degeneration of the knee joint.
• Secondary injuries to the knee or surrounding structures.
• Increased risk of developing osteoarthritis in the knee.
• Muscle weakness.

Types of LCL Injuries 

LCL injuries are referred to as sprains and are classified by grades, ranging from one (the least severe) to three (the most severe):

• Grade I sprain: This involves minor stretching or tearing of the ligament fibers, leading to mild tenderness, slight swelling, and minimal instability.
• Grade II sprain: This is characterized by a partial tear, resulting in moderate pain, noticeable swelling, and some joint instability.
• Grade III sprain: There is a complete tear, causing severe pain, substantial swelling, and pronounced instability.

Causes of LCL Injuries

LCL injuries are often caused by a variety of factors, primarily involving sudden or forceful movements that put pressure on the outside of the knee causing a strain on the ligament. Causes include:

• Direct impact to the inside of the knee
• Sudden changes in direction or twisting movements
• Overextension or hyperextension of the knee joint
• Falls that exert force on the knee
• Traumatic accidents impacting the knee joint
• Previous knee injuries weakening the ligament

Symptoms of LCL Injuries

Symptoms of an LCL injury can be mild or severe, depending on the severity of the sprain and whether it is torn. If the ligament is mildly sprained, the condition may be asymptomatic. For a partial tear or complete tear of the ligament, symptoms may include:

• Persistent pain on the outer side of the knee.
• Swelling, stiffness and tenderness.
• Instability of the knee.
• Limited range of motion.
• Popping or tearing sensation.
• Difficulty with physical activities.
• Weakness in the knee, particularly when trying to bear weight or move in certain directions.
• Altered gait.

Diagnosis of LCL Injuries

Diagnosing an LCL injury begins with a thorough medical history review and a physical examination. This involves assessing symptoms, understanding the circumstances of the injury, examining the knee’s structural integrity, and comparing the injured knee to the uninjured one. Additional tests include:

• X-rays: X-rays are used to rule out bone fractures or avulsion fractures (where a fragment of bone is pulled away with the ligament).
• Magnetic Resonance Imaging (MRI): An MRI is the most definitive imaging study for diagnosing an LCL injury. It provides detailed images of the soft tissues, evaluating the extent of the ligament tear and any associated injuries to other structures in the knee.
• Ultrasound: In some cases, ultrasound imaging might be used as a quick, non-invasive method to visualize the LCL and assess the injury.

Treatment Options for LCL Injury

Treatment for an LCL injury varies based on the injury’s severity and the patient’s activity level. For grade 1 and 2 injuries, nonsurgical options like bracing and physical therapy are typically most suitable, allowing for a gradual return to regular activities. In cases of more severe injuries, surgical intervention may be recommended.

Non-Surgical Options

• Bracing: Bracing is an important part of treatment and rehabilitation process, providing essential support and stability to the knee joint. A knee brace helps to limit excessive lateral movement and protect the injured ligament from further stress or injury during the healing phase. It also aids in reducing pain and swelling by compressing the affected area.
• Physical therapy: Physical therapy is an important part in the treatment of LCL injuries. It aims to restore function, improve strength, enhance flexibility, and prevent future injuries by guiding patients through a structured rehabilitation program. Exercises and training programs are typically tailored to the individual’s specific needs and the severity of the injury, progressing from basic to more advanced activities as healing occurs. Included are:
  • Range of motion (ROM) exercises.
  • Quadriceps activation.
  • Strengthening exercises.
  • Weight-bearing activities.
  • Proprioception training exercises.
  • Patellar mobility.
  • Dynamic stability exercises.
  • Neuromuscular training.
  • Functional training.
  • Agility training.
  • Aquatic therapy.
  • Manual therapy.
  • Functional Electrical Stimulation (FES).

Surgical Option

Most LCL injuries do not need surgical intervention, however surgery may be necessary for complete tears or when conservative treatments fail.

Surgery for an LCL injury is typically necessary when:

• Complete tears of the LCL resulting in significant knee instability and cannot heal properly without surgical intervention.
• LCL injury occurs in conjunction with other ligament injuries, such as ACL or PCL tears.
• Failure of non-surgical treatment
• When the LCL is torn off the bone, sometimes with a fragment of bone attached (Avulsion Fractures), surgical reattachment is necessary.
• Ongoing knee instability that significantly impacts daily activities and increases the risk of further

The specific surgical method is dependent on the nature and location of the tear:

• LCL Repair: This surgical procedure is indicated for acute, complete tears (grade III) or when the ligament has been avulsed from its bony attachment. During the surgery, an incision is made on the outer side of the knee to trim any damaged tissue. Strong, non-absorbable sutures are then used to reattach the ligament ends, often securing them to the bone using small anchors if necessary. In cases of avulsion, the bone fragment is reattached. The knee is then carefully closed and bandaged. Postoperatively, the knee is immobilized in a brace to protect the repair and allow initial healing.
• LCL Reconstruction: This surgical procedure is performed to restore the function and stability of the knee when the LCL is severely damaged or completely torn and cannot be repaired directly. This procedure is often necessary for chronic injuries, complex tears, or when the ligament quality is poor. During the surgery, an incision is made on the outer side of the knee to access the damaged area. The torn LCL is removed, and a graft, either from the patient’s own hamstring tendons (autograft) or a donor (allograft), is used to reconstruct the ligament. Tunnels are drilled into the femur and fibula at the original attachment sites of and the graft is threaded through these tunnels and secured with screws or other fixation devices. The knee is then closed and bandaged, and the patient is placed in a brace to immobilize the knee initially. When direct repair is not possible, the ligament is reconstructed using a graft. The graft can be an autograft (from the patient’s own body) or an allograft (from a donor). This procedure involves attaching the graft to the femur and fibula to restore stability.
• Combined Surgery: In cases where the LCL injury is accompanied by other ligament injuries (such as ACL or PCL tears), or other structures within the knee, a combined surgical approach may be necessary to repair or reconstruct multiple ligaments. During the surgery multiple incisions are made to access all damaged ligaments and structures. Each ligament is addressed accordingly: the LCL may be repaired or reconstructed using a graft, while the ACL or PCL may undergo reconstruction with their respective grafts. The procedure involves precise drilling of tunnels in the femur and tibia for graft placement and secure fixation with screws or other devices. Post-surgery, the knee is immobilized in a brace.

For all procedures, physical therapy begins soon after to restore range of motion, followed by strengthening exercises with the goal of restoring knee stability and function, enabling patients to return to their normal activities and reduce the risk of further injury.