The lateral collateral ligament (LCL)

Imagine a strong, slender bundle of ropes on the outer side of your knee. This is the structure of your lateral collateral ligament, or LCL for short. This bundle of fibres connect your thigh bone (femur) to your lower leg bone (fibula). The LCL acts like a stabilizer, protecting your knee joint from moving too much side-to-side.

Other ligaments in the knee

Besides the LCL, your knee has three more main ligaments. On the inside, there’s the medial collateral ligament (MCL), which works with the LCL to stop your knee from moving too far side-to-side. Deep in the center of the knee joint, you can find two cruciate (cross) ligaments, called the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). They help to control forward and backward movements of your knee and anchoring the knee joint.

Muscles Around the Knee

Around your knee, there are many incredibly strong and important muscles. The most well-known are the quadriceps at the front of your thigh and the hamstrings at the back. The hamstrings split into two, with one part connecting to the inside of the knee and one part connecting to the outside. Together with a smaller muscle called the popliteus, they help to control the rotation and forward movement of your knee. You can think of them as the engine and brakes for your knee. The LCL attachment intertwines with the attachments of these muslcles. So, often when one of them gets injured, the others will be injured as well.

Menisci: The Knee’s Shock Absorbers

Within your knee there are two C-shaped cartilage-type pads known as menisci. They serve as cushions or shock absorbers within the knee joint especially with a twisting movement. They also make the gliding action within the knee easier.

The Complete Picture: Your Knee Joint

All these parts — the LCL, muscles and menisci — work together. Unfortunately, they can also get injured together as well. It’s important to look at the bigger picture with a knee ligament injury.

The knee’s side protector

Imagine the lateral collateral ligament (LCL) as a guardian positioned on the outside part of your knee. Its role is to prevent the knee from buckling sideways.

The team player

The LCL doesn’t operate solo; it’s part of a team. Alongside companions like the kedial collateral ligament (MCL) on the inside and the cruciate ligaments (ACL and PCL), they collaborate effectively as a team. This teamwork is what gives your knee the best stability. Ultimately giving you the ability to squat, run, jump or hike up a mountain.

A feedback friend

The LCL also acts like a messenger. By keeping the knee stable, it helps your body to sense your knee’s position in space. This is called proprioception and it’s like having a sixth sense for your knee, so you can move without having to think about every step.

The Balance Keeper

Doing things like dancing, leaping, turning or taking part in sport requires a lot of balance and coordination. The LCL, together with the other ligaments in your knee give you the ability to maintain your balance and stability on one leg. This helps you to move confidently and gracefully.

The Side Swipe

Imagine you’re playing a sport or simply walking, and suddenly you bump your knee’s outer side hard against something, or someone hits it from the inside. This kind of hit is what usually causes an LCL injury. It’s like someone pushing you sideways when you’re not expecting it, and your knee takes the brunt of it.

Twist and Shout

Another way the LCL can get hurt is if your knee gets twisted while your foot is planted firmly on the ground. It’s like trying to turn quickly while your foot is stuck, and your knee feels the twist. This sudden twist can stretch the LCL too much or even tear it.

Overstretching

Sometimes, if you move your leg too far outward, the LCL can get overstretched. Think of it like pulling a rubber band too far – it can strain or even snap. This happens to the LCL when the knee is forced to bend in a way it’s not meant to.

The Breakdown

When the LCL gets hurt, it might just stretch too much, get partially torn, or in severe cases, completely tear apart. The severity depends on how much force your knee faced. It’s like a rope that’s frayed or snapped depending on how much pressure it’s under.

The Consequences

When the lateral collateral ligament (LCL) is hurt you may experience a sense of instability in your knee particularly when attempting sideways movements or engaging in activities requiring movement of your knee. Without care and adequate rest, this injury can stop your tasks such as walking or climbing stairs, and it will end up causing discomfort and difficulty. It is crucial to provide the attention it needs to facilitate your knee’s return to its role – as a robust and dependable part of your leg.

• Direct Blow to the Inner Knee

  : A strong impact, to the inside of the knee leads to an increased stretch of the outside of the knee. In football, a common reason for LCL injuries is a hit to the knee during tackles leading to a notable number of knee ligament injuries in the sport.

• Twisting Movements: Twisting your knee, with your foot planted in one place can easily injure the lateral side of the knee and LCL. This frequently occurs in sports when athletes pivot, turn or change direction quickly.
• Hyperextension: Over-straightening your leg into an extreme range can also injure the LCL (as well as other ligaments). This is like bending a ruler backward until it starts to strain. An example of this when a gymnast or acrobat needs to land with a hyperextended knee. 
• Landing after a jump: Landing on an unstable surface or even falling over after you land, can easily put too much strain on the outside of your knee. This leads to a strain injury of the lateral knee.

Mild LCL Injury (Grade I)

A mild LCL injury, classified as Grade I, may cause pain and tenderness on the outer part of your knee. The swelling is usually minimal. When you bend your knee sideways (such as during a Varus stress test), you may experience some discomfort. However, your knee should not feel unstable or loose. This type of LCL injury typically indicates that your ligament is strained rather than torn.

Moderate LCL Injury (Grade II)

On the other hand, a moderate LCL injury, categorized as Grade II, can be more painful. You are likely to experience increased soreness and pain on the outer part of your knee along with swelling. During the Varus stress test, there will be more discomfort. Your knee may feel slightly unstable. This suggests that your ligament is partially torn, which is greater than just a strain.

Severe LCL Injury (Grade III)

In a severe LCL injury, the ligament is fully torn. Surprisingly, there are instances where the pain may not be as intense, as a grade II injury. However, the issues are more severe. You may still experience pain and sensitivity on the part of your knee along with swelling. When you check your knee by bending it you will notice a looseness indicating that the ligament is not providing the necessary support. This kind of injury can lead to a greater sense of instability in your knee.

Other Injuries that come with LCL Injuries

When your LCL is injured it’s not unusual for other parts of your knee to suffer damage well. Additional ligaments, in your knee, such as the Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL), or the Posterolateral Compartment (PLC) a group of tissue structures at the back of your knee may also be affected. In some cases the injury might be severe enough to cause a dislocation where the bones are displaced. Occasionally there could also be damage to the menisci, which act as shock absorbers inside your knee. Keep an eye out for injuries to the back or side of your thigh, like hamstring or Iliotibial Band Syndrome.

We are confident to diagnose your lateral collateral ligament (LCL) sprain as skilled physiotherapists. We make our priority to locate the exact reason for your knee pain and from there formulate a treatment plan that will suit you lifestyle. With the right knowledge about the anatomy of your knee, we can look at the bigger picture and see if you have injured any surrounding muscles or joints.

To start off with the diagnostic procedure of a LCL sprain, we get a complete history of your injury and symptoms. After that, we do a thorough physical examination of your knee:

• Palpation: We feel for tenderness, swelling, increased warmth, pain response or muscle spasm.
• Range of Motion: It is important to measure how far you can bend and straighten your knee before you feel stiffness or pain.
• Muscle Strength Testing: With any ligament injury, you’ll always have accompanying muscle pain or injury. By testing the strength of muscles like your quadriceps and hamstrings, we’ll be able to identify any muscle dysfunction and measure your knee stability.
• Special Tests: Stretching and stressing the ligaments around your knee help to identify which ligaments were injured.

Ligaments cannot be seen on an x-ray, so it won’t be the first choice of investigation to use. However, x-rays can show the bone structure of your knee joint and can help to rule out any fractures.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound can be used to show the presence of a tear in the ligament. It will also be used to assess the surrounding soft tissues and amount of swelling and fluid.

If you need an ultrasound, your physio will refer you.

An MRI is the gold standard for seeing the full extent of a knee injury. It will be able to show us bones, ligaments, nerves, tendons, cartilage and swelling. However, it is an expensive option and you need to be referred by a specialist doctor to get this test.

Your physiotherapist can refer you to the appropriate specialist if you need to get a scan like this.

Delayed healing and chronic inflammation:

Your LCL may not have fully healed, leading to continued discomfort. Because your injury does not heal properly and can keep getting injured, this may lead to chronic inflammation. This inflammation will result in the formation of scar tissue can limit movement and cause discomfort.

Complications and Muscle Imbalances:

Other injuries or conditions, like Baker’s Cyst or Arthritis, might have developed. This may develop because the supporting muscles of your shoulder were not strong enough to stabilize the knee, which will put you at risk of developing other painful conditions of the knee.

Improper Treatment and Underlying Conditions:

The initial treatment might not have addressed the root cause or severity of the injury. Not only may improper treatment affect the recovery of your shoulder, there may also be factors that you may have not considered such as Diabetes, Osteoporosis or Rheumatoid Arthritis.

Not using protective gear properly

It is not uncommon for people to place themselves in a sling for either too short or too long of a time. This may lead to inadequate healing or cause the shoulder to become weak and dependent on the sling for their pain.

Treating the wrong problem or not completing treatment at all

Not getting a proper diagnosis from the start is another issue. It wastes valuable time and delays appropriate treatment. Failure to identify the root cause of your heel pain leads to ineffective treatment. Patients often try out various forms of treatment but fail to complete them. Committing to a consistent and comprehensive treatment plan under professional guidance is essential for effective recovery.

Rest and pain medication alone won’t solve the problem

Relying on medication can mask the pain without addressing the root cause of the problem. Finding the balance between resting and safe movements is key to recovery. People tend to think that they can stretch the pain away, but usually it makes the problem worse. It’s important to follow a guided exercise program with a combination of different types of exercises for different muscle groups. Resting too much or too little can be detrimental. Too much rest leads to weakness and stiffness and deconditioning. Too little rest simply prolongs the inflammation.

As experienced physiotherapists, we understand that a lateral collateral ligament injury is painful and frustrating to recover from. We want to assure you that together, we can create a treatment plan to guide you through recovery. It will include a combination of techniques designed to reduce your pain and inflammation, and to improve your shoulder mobility and strength.

• Manual therapy: Hands-on techniques, like soft tissue mobilization and joint mobilization, to decrease your pain and increase your range of motion of your knee.
• Therapeutic exercises: We’ll work together on targeted exercises to strengthen and stretch the muscles around your knee. This usually includes working on the muscles of the front and the back of your knee.
• Activity modification: Initially, we guide you to modify your daily activities and exercise to minimize stress on your knee.
• Pain management and Education: Giving you the information you need to understand your pain, helps with long-term pain relief. We can advise you on different pain-relief strategies that are both safe and effective.
• Other effective modalities: We will also use pain management techniques such as Dry Needling and Electrotherapy that has been proven to manage pain. Strapping can also be used to protect the injured area so that the joint may heal properly.

The goal is to help you get back to your daily life and exercise routine as soon as possible, while minimizing the chances of hurting your ligament, or other important structures in and around your knee.

Acute Phase (Days 1-7):

• Pain and Swelling: Right after the injury, you’ll probably feel quite a bit of pain on the outer side of your knee, and it might swell up too.
• Relative Rest and Protection: It’s important to give your knee a break during this time. You might need to use a brace to keep your knee stable and take the pressure off the LCL. This will protect the ligament while preventing the rest of your muscles from getting weaker.
• Ice and Elevation: Applying ice and keeping your knee raised can help reduce swelling and pain. This will provide a safe way to reduce your pain without any unwanted side effects such as impaired healing.

Subacute Phase (Weeks 1-6):

• Reduced Pain: As time goes on, the pain should start to get better, and the swelling will go down too.
• Gentle Movement: You can start doing some gentle exercises to get your knee moving again, but it’s important not to push it too hard. We can guide you on what’s safe to do.
• Strength and Stability: As your knee starts to feel better, you’ll work on building up the strength in your leg muscles and improving the stability of your knee.

Remodeling Phase (Weeks 6-12+):

• Continued Improvement: By now, your knee should be feeling a lot better, but you might still be working on getting back to 100%.
• Advanced Exercises: You’ll be doing more advanced exercises to make sure your knee is strong and stable enough to handle your usual activities. This can include sports or getting through your work day without feelings of instability or pain.
• Gradual Return to Activity: Depending on how severe your injury was, you might be able to start getting back to sports or other activities around this time. It’s important to listen to your body and not rush things.

• Doctor

  : Your doctor can assist you with a diagnosis and a prescription for pain medication if necessary. Medication is a handy tool in your recovery process, but it should be used with guidance and in combination with rehabilitation. The use of cortisone is not recommended.

• Biokineticist: Rehabilitation can also be guided by a biokineticist, especially when you need help to return to your exercise routine or sport.
• Chiropractor: Trying to ‘click’ your knee joint ‘back into place’ after an injury like this is not recommended. It can flare-up the inflammation process or worsen the ligament tear.
• Orthotist: An orthotist can recommend and prescribe a knee brace and crutches according to the severity of your injury. A brace can help with healing, especially in the acute phase of your injury. However, there should be a management plan in place, to make sure that you move and use your knee independently again.

Surgery may be necessary for an LCL injury if the ligament is completely torn, the knee is highly unstable or if other knee structures are also affected. Before opting for surgery, we will assess the extent of the injury to the knee’s functionality, as well as your activity level and objectives.

It’s important to understand that surgery marks the beginning of your knee’s healing process. The real work starts after the surgery as the body needs time to heal and regain the strength it needs to adapt to the new changes. Rehabilitation after surgery plays a role in reducing swelling and pain, restoring knee movement, improving muscle strength and getting you back to your previous activities.

There are different surgical techniques that may be chosen. The first involves a reconstruction using a graft to replace the torn ligament while another technique such as repair entails stitching together the torn ends. Regardless of the approach taken, post-operative rehabilitation is integral for a full recovery, by aiding you in regaining the stability and function of your knee.

• Iliotibial band syndrome: Pain at the outside of your knee, thigh or even hip. Typically caused by overuse and very common in runners. 
• Meniscus tear (lateral meniscus): This is an injury of the extra cartilage layer inside the knee joint. It often causes a clicking or locking sensation in your knee. Caused by a twist injury of your knee. .
• Cruciate ligament injury (ACL or PCL): These ligaments are found inside the knee joint. It protects the tibia from sliding forward or backward on the femur. Very common to injure it when you have to change direction or stop suddenly.
• Lateral hamstring tendinopathy: The outside part of the hamstring tendon attaches onto the knee. Close to the LCL. Tendon pain often feels worse when you exercise and afterwards as you cool down. Severe stiffness of your knee the next morning.

• LCL sprain
• Lateral ligament tear
• Tear of the lateral collateral ligament
• Injury of the lateral knee ligament