Article by Sydney sports physio, Chris El-Hayek
What is the Role of the LCL?
The LCL is a ligament on the outside of the knee, that connects to the thighbone (femur) at the top, and the fibula (near our shin) at the bottom. This ligament helps to stabilise the knee from excessively collapsing outwards.
How Does an LCL Injury Occur?
LCL injuries typically occur when varus stress (outwards stress) is placed on the knee. This can happen when the knee is hit on the inside from someone else while your foot is planted, causing excessive stretch of the LCL ligament on the outer knee. This typically happens in sport, where the athlete’s inner leg is hit or tackled forcefully. It is not common for this mechanism to occur. Other mechanisms that can injury the LCL include knee hyperextension, or an awkward change of direction where the planted foot gets stuck. Although the LCL can tear in isolation, they are commonly associated with injuries to other areas of the knee as well, including the ACL and meniscus.
Injury Severity & Duration
LCL ligament injuries are usually graded from 1-3, depending on how much of the ligament has been torn. In some cases, there can be a small stretch of the ligament that can be labelled as grade 0, and function would return rapidly in this situation, however the mechanism of injury to the LCL means it may be typically be more of a problem than this.
Grade 1 – Minor ligament injury, can still be painful with mild associated swelling and tenderness. Strength and function are usually still good, and there wouldn’t be much joint laxity. Return to activity may take 2-4 weeks.
Grade 2 – Moderate ligament damage, with higher levels of pain and associated swelling. May have increased joint laxity on physiotherapy orthopaedic assessment (known as the varus stress test). Range of Motion (ROM) braces can be used to improve stability and healing of the ligament as determined by your physio. This usually consists of wearing a brace in locked at 30-90 degrees of flexion for a period of time, and in some cases, 60-90 degrees. The range will vary depending on your joint laxity, and overall function. You will typically be out of sport for 4-8 weeks with this injury.
Grade 3 – High grade ligament tear, or in some cases complete rupture of the LCL ligament. This would always need a ROM brace (minimising knee extension as a priority), and crutches in the early stages. Review from an orthopaedic specialist is needed for a surgical opinion depending on the extent of damage. Generally, you may be out of sport for at least 3+ months. Unfortunately, a grade 3 LCL injury is often associated with significant injury to other structures, such as the ACL, meniscus, and other stabilising structures within the posterolateral corner of the knee.
Medical Imaging
If there is suspicion of an LCL injury, an MRI is gold standard in confirming the diagnosis and overall nature, extent, and location of injury. Because LCL injuries are less common, and often associated with injuries to other structures in the knee, our approach at Optimise is to ensure nothing is missed with early MRI referral. If there is any concern for associated fractures, an Xray can also be done quickly (with no booking is required) to rule this out while waiting for the MRI.
Above: MRI Imaging showing complete tear of a patient’s LCL
How a Physiotherapist can Help in the Treatment & Management of an LCL Injury
LCL injuries need early diagnosis to ensure the structure is given the right management for early stabilisation and healing. In your physiotherapy appointment, we will quickly determine whether you need a ROM brace. If so, we will refer you for medical imaging (Xray and/or MRI) if necessary.
Once your diagnosis is confirmed, you will quickly start your treatment and rehabilitation. This will consist of pain and swelling management strategies in the early stages, (manual therapy, using Normatec compression boots, and our Electrical Muscle Stimulation device –
Compex in some situations). You will be assessed regularly to gauge your level of tissue healing, strength, power, and mobility. Exercise rehabilitation will commence as early as safely possible, with ongoing monitoring.
During your mid to late-stage rehabilitation, strength & conditioning and injury prevention strategies will be implemented so you return to full function, and minimise the risk of re injury when you return to sport. Most importantly, we work with you on all the athletic capacities required for you to perform in your sport, including your endurance and agility.
Do you need assistance managing or treating a knee ligament injury?
Our sports physiotherapists have extensive expertise in offering physiotherapy services to a range of patients in varying sports from grassroots to international level. We experience assessing and treating numerous athletes with a wide range of complex sport related knee injuries post operatively and conservatively, with high success in minimising re injury while enhancing our patients athletic qualities.