Lateral Colateral Ligament (LCL) strain
What is an LCL sprain
Your lateral collateral ligament, commonly abbreviated to LCL is the thick band of fibrous tissue on the outside of your knee joint. This can be seen on the knee anatomy picture here. Its primary role is to provide stability for the knee joint. Ensuring that movement that cannot be controlled by your muscles does not occur. The knee is often referred to as a hinge joint, it has good control of bending and straightening, but needs your collateral ligaments (your LCL works along side your medial collateral ligament) to control side to side movement. Specifically your LCL controls movement where your foot moves inward in relation to your knee, or your knee is pushed outward in relation to your foot. This results in the LCL being stretched.
LCL injuries are not as common as MCL injuries. In truth it is often a pretty unique set of circumstances that leads to an isolated LCL sprain. Due to the internal anatomy of the knee and the direction of force that is required it is more common that the LCL is damaged with other internal structures within the knee.
We tend to categorize LCL strains based on the amount of damage caused
Mild or grade 1 - Resulting from mild force causing inflammation of the LCL but no significant structural damage.
Moderate or grade 2 - When compared to a grade 1 the force in a grade 2 does actually cause a partial tear or partial rupture of the LCL. You may need to wear a hinged knee.
Severe or grade 3 – Where as grade 1 and 2 could be termed a sprain, really a grade 3 is a total rupture. The force this time causes a complete disruption of the ligament.
Grade 3 sprains are commonly seen as part of a knee dislocation therefore are often associated with injury to the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament and the structures of the back of the knee. It is also perfectly possible that the nerve that runs down the side of the knee (peroneal nerve) and even some of your blood vessels could be damaged in this type of injury.
What are the symptoms of LCL injury?
As you can imagine the amount of symptoms you may get depend on the amount of force and thus the severity of the injury. It is virtually always possible to pinpoint the time and reason for the onset of symptoms.
Symptoms of pain, tenderness and stiffness are common. These are usually felt over the LCL itself on the outside of the knee. It is also common for the knee to swell up after a number of hours.
If the knee appears to swell up immediately this would be unusual, raising the possibility of another type of injury, such as ACL rupture or fracture. If your bruising is quite substantial then this might represent a substantial injury to the knee and you should seek specialist advice.
If you notice after injury that your foot goes floppy, that you cannot lift you foot up (known as foot drop), then this could be an indicator of nerve damage and you should seek immediate medical attention. The same should be said if you notice any changes in circulation (colour, coldness) to your foot or lower leg. This is another reason to seek immediate medical attention.
It is common that over the first few days the knee might stiffen further. You may also develop bruising dependent on the severity of the injury.
As time progresses and you start to return to some normal activities you may find that your knee feels a little unstable, as if you cannot trust it so well.
What can I do for myself?
Early management - LCL strain is a soft tissue injury, as such following the advice regarding acute soft tissue injuries here is a great place to start. It would be fair to suggest that early good quality injury management means that you should improve as quickly as possible. This is a service we are able to offer.
If you have significant pain and certainly bruising it is worthwhile seeking a specialists opinion. These features may suggest a grade 2 or 3 injury were it would be a good idea to be assessed as to whether you need a brace or not. Also the kind of force that can produce significant swelling, bruising and pain may have led to a different significant injury.
In the first instance when you have undertaken the acute soft tissue treatment you should try to regain your range of motion. The ability to full straighten and fully bend your knee. This exercises may be of help.
Recovery phase – Once you have noticed your knee starting to feel somewhat easier with the early management it is a good idea to start to think about recovery:
- Regaining full flexibility
- Regaining full strength
- Returning to previous levels of activity
As well as these flexibility exercises, you should also start to work your muscles. These simple exercises may be of use at the beginning.
Once you start this journey how far you continue depends on what you wish to get back to doing. If you have a specific sport or hobby that you wish to return to then gaining the help of a rehabilitation specialist would be advised. This is something we would be able to help you with.
What other treatments are available?
Physiotherapy is the mainstay of the treatment of grade 1 LCL sprain. With a good rehabilitation program you should regain all your previous abilities. Similarly an isolated grade 2 injury needs only high quality physiotherapy treatment. However the likelihood of a concurrent injury to other structures of the knee means that a specialist opinion is a good idea. This is certainly something we can offer.
Grade 3 sprains of the LCL and the high likelihood that other damage may have occurred within the knee means that to reach full recovery surgical procedures may well be required. Obviously the form that this may take depends on the issues at hand.