The LCL or lateral collateral ligament is a cord like structure which supports the outside of the knee joint by attaching the fibula (outside bone of the calf) to the femur (thigh bone). A ligament does not join onto a muscle like a tendon does, so is called a “static stabiliser” of a joint rather than a “dynamic stabiliser” such as muscles and tendons which have the capacity to contract. The LCL is designed to protect the knee joint from excessive movement to the outside of the leg, along with various other structures such as the biceps femoris tendon (hamstring), and is taught when the knee is straight and loose when the knee is flexed.
A ligament becomes damaged when it is stretched beyond its capacity to recover, rather like an elastic band that’s stretched too tight. The damage is usually graded in I, II or III, with grade I a mild sprain, grade II a partial tear, and grade III a complete tear. To diagnose which of these it is your therapist will assess and examine your knee, and may then refer you for further investigation if a grade III tear is suspected. The signs and symptoms that are typical for each grade are as follows:
- Mild tenderness and pain over the outside of your knee where the LCL lies.
- Very little or no swelling.
- The knee will feel stable to you and to the therapist when they examine you using a special test called a varus test which replicates the movement of the knee joint to the outside.
- The varus test will be slightly painful in some positions.
- Some tenderness and pain on both the outside and slightly to the back of the knee.
- Swelling in the area of the LCL.
- The varus test will be painful, and there will be some instability.
- Conversley once the ligament is ruptured it may be less painful, but this varies on an individual basis.
- Significant swelling of the knee on the outside and more generally around the joint.
- The varus test will show a great deal of movement/instability.
- The knee may feel very unstable to you.
HOW DO WE FIX IT?
Grade III LCL injury will need to be managed by an orthopaedic consultant alongside your therapist and is often treated with a surgical repair followed by rehabilitation. Grade I and II are usually managed without surgery, and the acronym PEACE & LOVE provides a good framework for this.
The aim of this phase is to manage the swelling and pain, and get the knee joint mobile again. This might include using crutches where necessary, using a compression sleeve to help control the swelling, using isometric contraction exercises of the quadriceps and calf muscles to help the pain and mobilising the knee joint back into normal range.
The aim here is to achieve full weightbearing, and full active range of movement of the knee. Strength exercises for the lower leg will be introduced, including closed chain work (where the foot is on the floor), and work on your balance.
LATE STAGE/ RETURN TO PLAY AND LIFE!
The aim now is to get you back to doing all the things you love, and to ‘future proof’ you to try to reduce the risk of reinjury. This stage might include working on your balance further, plyometric (speed and jumping) exercises, high level strengthening, gait analysis, aerobic, capacity and endurance exercises depending on your specific goals.
An injury doesn’t need to mean cessation of all activities! As soon as pain allows you can do exercise such as upper body strengthening, swimming with a ball or noodle between your legs, use a seated ski erg or even hand cycling to work on your cardio, so there’s lots of options.
A positive attitude and lots of optimism have been shown to improve post-injury outcomes so it’s good to stay positive.
And finally, commit to your rehab and look at this as an opportunity for growth and development- you’ll come back better than ever!
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