Lateral Collateral Ligament Tears

What causes a tear of the lateral collateral ligament?

Tears to the lateral collateral ligament most often occur from a direct blow to the inside of the knee. This can stretch the ligaments on the outside of the near too far and may cause them to tear. This type of injury occurs in sports that require a lot of quick stops and turns such as soccer, basketball and skiing, or ones where there are violent collisions, such as football and hockey.

The ligament can also be injured by repeated stress that causes it to lose its normal elasticity. Most knee injuries are to the ligaments that support the knee, not the knee joint itself.

What are symptoms of a torn lateral collateral ligament?

Symptoms of a torn lateral collateral ligament include:

• A feeling that the knee may give way under stress and isn't stable
• A locking or catching in the joint when it is moved
• Numbness or weakness in the foot may occur if the peroneal nerve, which is near the ligament is stretched during the injury or is pressed by swelling in surrounding tissues
• Pain that can be mild or acute
• Stiffness
• Swelling and tenderness along the outside of the knee

How is a tear of the lateral collateral ligament diagnosed?

Your doctor will generally ask you how the injury occurred, how your knee has been feeling since the injury and whether you have had other knee injuries. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you.

Your injury will be classified as follows:

• Grade 1 — Some tenderness and minor pain at the point of the injury. This means there have been small tears in the ligament.
• Grade 2 — Noticeable looseness in the knee (the knee opens up about 5 millimeters) when moved by hand. There is major pain, tenderness and swelling on the inner side of the knee. This means there have been larger tears in the ligament, but it is not completely torn.
• Grade 3 — Considerable pain and tenderness at the inner side of the knee; some swelling and marked joint instability. The knee opens up slightly less than half an inch when moved. A grade 3 LCL tear means the ligament is completely torn. There may also be a tear of the anterior cruciate ligament.

If there is too much pain and swelling to accurately judge how serious the injury is, your doctor may recommend that you wear a light splint, apply ice and raise your knee. Once the swelling and pain have gone down somewhat, he or she can then make the diagnosis.

Your doctor may order a magnetic resonance imaging (MRI) scan. An MRI has an accuracy rate of nearly 90 percent in determining whether and how badly a lateral collateral ligament has been torn.

How is a tear of the lateral collateral ligament treated?

Lateral collateral ligament tears do not heal as well as medial collateral ligament tears do. Grade 3 lateral collateral ligament tears may require surgery.

In some cases, all that is required is rest, wearing a brace, taking pain relievers such as ibuprofen and having physical therapy.

Your doctor may recommend that you wear a lightweight cast or brace that allows your knee to move backward and forward but restricts side-to-side movement. This is usually worn for 72 hours. Depending on how well it reduces your pain and swelling, you may be able to start a rehabilitative program in a few days.

When the pain and swelling have gone down, you should be able to start exercises to restore strength and range of motion to your knee. If you still have soreness while doing these exercises, go slowly to prevent further irritation. It may take up to eight weeks to fully recover, depending on the grade of your injury.

If the lateral collateral ligament was torn where it attaches to the thighbone (femur) or shinbone (tibia), the surgeon will reattach the ligament to the bone using large stitches or a metal bone staple.

If the tear happened in the middle of the ligament, the surgeon will typically sew the torn ends together.

If the damage was so severe it cannot be repaired, your surgeon may reconstruct a tendon by using a graft taken from a tendon of your thigh muscles (quadriceps) or your hamstrings.

Lateral knee reconstruction is an open-knee procedure, meaning it is not done arthroscopically. The tendon graft is passed through bone tunnels and fixed to the thighbone and lower leg bone using screws or posts or with stitches tied around a post.

Key points

• Tears to the lateral collateral ligament most often occur from a direct blow to the inside of the knee. This can stretch the ligaments on the outside of the near too far and may cause them to tear.
• This type of injury occurs in sports.
• Lateral collateral ligament tears do not heal as well as medial collateral ligament tears do. Severe tears may require surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.