Managing LCL Sprains

Symptoms Of An LCL Sprain

A sprain to the LCL (lateral collateral ligament) of the knee may vary from being very mild, to a complete ligament rupture. LCL sprains are categorized into Grade 1, Grade 2, or Grade 3 depending on the extent of the injury, with a Grade 3 injury being a complete rupture of the ligament. The symptoms and recovery time frames depend on the degree of stretching, or tearing of the ligament. If there is only a mild sprain to the ligament there may only be very mild symptoms, with partial tears, or complete tears potential symptoms may include:

• Pain felt on the outside of the knee.
• Swelling, usually again located to the outside of the knee.
• Stiffness of the knee, either a limitation of full range of movement, or a sensation of stiffness through movement.
• Feelings of instability, patient reporting that it feels like the knee is going to give way. This sensation is most commonly associated with twisting, or turning actions, when pivoting on the injured leg.

Diagnosing Lateral Collateral Ligament Injuries

Generally simple questioning regarding the history of the event, coupled with physical examination of the knee and your physiotherapist should be able to confirm a clinical diagnosis of a LCL injury and grade the extent of injury without the need for investigations. However, with high grade injuries given that management can require a period of immobilization in a ROM brace, or the detected laxity may be the result of an avulsion fracture where the ligament has not torn, but when stressed injury caused a “chunk” of bone to pull off with it. Due to these and other complications if there is access to X-ray and MRI these investigations can significantly aid diagnosis, assess the status of surrounding structures and assist in planning the treatment approach. As mentioned in the previous lateral collateral ligament blog, it isn’t uncommon for combination injuries to occur, injuries where the trauma has impacted more than just the LCL of the knee being injured in isolation. Associated structures including the PCL, ACL, or menisci may also sustain injury, in which case an MRI is a very useful investigation in grading injury severity to structures lying deep in the knee. ACL injuries are often treated via surgical reconstruction, avulsion fractures may require surgical pinning, meniscal injuries may benefit from surgical repair and high grade injuries to collateral ligaments are frequently put in range of movement braces to protect the ligament from re-injury and over stretching during healing… Because of this as I previously mentioned, if available and the knee injury is considered moderate to severe then I would frequently recommend orthopaedic referral and likely MRI.

LCL Injury Treatment And Recovery

The management and healing time frames of LCL sprains vary depending on the severity of the injury and any involvement of injury to surrounding structures. Some simple guidelines regarding return to play time frames following a LCL injury are:

• Grade I sprains, athletes will usually heal within a few weeks and people may return to play within 10-21 days post injury.
• Grade II sprains, can take around 6 weeks to heal and any return to play will be in the vicinity of 6-12 weeks post injury.
• Grade III sprains, these injuries take considerable longer and any return to play isn’t until 3 months, or longer post injury.

Noting that the above time frames are simply guidelines, as the presence of any combination injury to surrounding structures can complicate the rehabilitation. Not to mention that individuals heal at different rates and the exact severity “within” the grade can vary, meaning the grades are a basic guideline and a mild Grade 2 verses a severe Grade 2 ligament will recover at different rates. On top of this the demands of individual sports the patient is returning to vary, and their dedication to any rehabilitation program will all influence someone’s time to return to play. All this will mean that some athletes can return to play sooner than others with limited risk to compromising their healing despite being told that they both had the same “grade” injury.

Physiotherapy And Lateral Ligament Injuries Of The Knee

Physiotherapy during the rehabilitation period following injury may consist of:

• Soft tissue techniques to the ligaments, or surrounding tissues.
• Home, in-clinic, or gym exercises which may include mobility work, strengthening, stability and balance exercises.
• With more significant ligament injuries, bracing and crutches may be necessary early on to protect the ligament whilst it is recovering.
• Moving towards the final stages of rehabilitation, when returning to training and play, bracing, or taping options may be considered to help support the ligament and to help prevent re-injury.

With Grade 3 injuries to the LCL, or combination injuries surgery is sometimes considered necessary to achieve the most desirable outcome. In this situation a ligament repair, or ligament reconstruction being the common choices carried out by orthopaedic surgeons.

Prevention Of Lateral Ligament Injuries

It’s difficult to totally prevent any injuries and LCL injuries are no different, because lateral knee ligament injuries are commonly the result of an unforeseen circumstance, accident or violent trauma such as a rugby tackle. However, if having suffered a lateral collateral ligament sprain then preventing any recurrence is obviously a priority, a comprehensive knee strengthening, balance and sports specific agility and technique program, coupled with avoiding any premature return to high-risk activities is probably the best way to reduce any likelihood of repeat injury. This approach potentially coupled with prophylactic taping, or bracing of the lateral collateral ligament help create a recipe for a safe return to play. Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Managing LCL Sprains should consult his or her general practitioner, sports medicine specialist, orthopedic surgeon, physiotherapist or otherwise appropriately skilled practitioner.