An LCL sprain refers to a tear in the knee’s outer ligament. It usually results from a direct blow to the knee’s inside but can also arise from repetitive overuse.
Medically reviewed by Dr Chaminda Goonetilleke, 13th Dec. 2021
Symptoms of an LCL sprain
Key symptoms of a lateral collateral ligament (LCL) sprain include:
- Outer knee pain
- Variance in severity, extending to a complete ligament rupture
- Possible swelling over the joint’s exterior, typically in severe cases.
Lateral Collateral Ligament (LCL) Sprains Grades:
- Grade 1: Features outer knee tenderness, minimal to no swelling, and pain but no joint laxity during the varus stress test.
- Grade 2: Significant outer knee tenderness, possible swelling, pain, and some joint laxity during the varus stress test, but with a clear endpoint, indicating ligament integrity.
- Grade 3: Complete ligament tear. Pain levels may vary, potentially less than grade 2. The varus stress test shows significant joint laxity without a firm endpoint, signifying potential knee instability.
A comprehensive examination is required post-swelling and pain reduction for an accurate assessment.
Imaging
For severe cases, an MRI scan or X-ray may be required.
Anatomy
The Lateral Collateral Ligament (LCL) links the femur (thigh bone) to the fibula’s top (shin bone). This strong collagen cord provides outer knee stability. Unlike the medial ligament, it’s not connected to the lateral meniscus, thus LCL sprains usually exclude meniscus tears. However, simultaneous injuries may occur to the anterior or posterior cruciate ligaments.
Causes
The LCL typically sustains injury through direct impact on the knee’s inner surface, as in rugby or football tackles. Such force opens the joint outside, stretching the lateral ligament. LCL sprains are less frequent than medial collateral ligament sprains.
Treatment
Immediate application of PRICE principles (Protection, Rest, Ice, Compression, Elevation), succeeded by a comprehensive rehabilitation program.
Treatment Protocol:
Cold Therapy: Apply a cold and compression wrap immediately post-injury, continuing in 10-15 minute intervals every few hours until symptoms improve.
Rest: Ensure complete rest until daily activities are pain-free for acute injuries. For chronic injuries, active rest, or abstaining from activities causing pain, is recommended.
Supports & Braces: A hinged knee brace, particularly crucial for grade 2 and 3 injuries, offers joint support and protection, safeguarding against lateral movements.
Taping: Support taping by your physio aids in knee protection and support during healing, enhancing confidence and proprioception upon return to running.
Sports massage for LCL sprains
Cross-friction massage, performed on the ligament, aids in minimizing scar tissue and aligning healing ligament fibres. Prior to treatment, your therapist will rule out contraindications for massage. During the acute stage—typically the initial 48-72 hours post-injury, possibly longer for grade two and three strains—this technique should not be used. The massage begins gently, increasing in intensity as you adapt.
LCL sprain Surgery
For grade 3 sprains, especially with concurrent ACL or PCL damage, surgery might be required to ensure future knee stability. The surgeon may stitch the torn LCL ends or reconstruct the ligament using a tendon portion, such as a hamstring tendon.
