LCL Injury

LCL Injury - Lateral Collateral Ligament

 

Article by J.Miller, Z.Russell, A.Clarke

LCL Injury

Lateral Collateral Ligament

Your lateral collateral ligament (LCL) is a cord-like ligament on the lateral (outer) side of your knee that forms part of the posterolateral corner. It originates from the lateral femoral epicondyle, joins the bicep femoris tendon before attaching to the head of the fibula. It is one of four major ligaments that help you to stabilise the knee joint. LCL sprain is the most common form of LCL injury. In isolation, a lateral collateral ligament injuries only account for 2% of all knee ligament injuries. Most LCL injuries occur in combination with, damage to other knee ligaments and structures: e.g. ACLmeniscus and posterolateral corner.

What Causes an LCL Injury?

The primary function of your lateral collateral ligament is to resist varus force and external tibial (shin bone) rotation. This force occurs if your tibia/foot is forced inwards to the knee or when your foot is grounded, and your knee twists medially.

The LCL is injured when the varus force is too high for the ligament to resist. The ligament overstretches. This overstretch can occur through a sharp change in direction, twisting the knee on a planted foot. Othe causes include incorrect landing technique, hyperextension of the knee or a blunt force hit to the knee, such as in football tackle or a motor vehicle accident. The incident usually needs to happen at speed, but muscle weakness or incoordination predispose you to a ligament sprain or tear.

LCL Injury Severity?

The severity and symptoms of a knee ligament sprain depend on the degree of stretching or tearing of the knee ligament. You may notice an audible snap or tearing sound at the time of your ligament injury.

In a mild, Grade I, LCL sprain, the knee ligament has a slight stretch, but they don’t tear. Although the knee joint may not hurt or swell very much, a mild ligament sprain can increase the risk of a repeat injury.

With a moderate Grade II LCL sprain, the knee ligament tears partially. Knee swelling and bruising are common, and the use of the knee joint is usually painful and challenging. You may have some complaints of instability or a feeling of the knee giving way.

With a severe Grade III sprain, the ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and can be difficult to bear weight. You may have a feeling of the knee giving way. Often there will be no pain or severe pain that subsides quickly following a grade 3 tear as all of the pain fibres are torn at the time of injury. With these more severe tears, other structures are at risk of injury, including the meniscus or ACL.

How is an LCL Injury Diagnosed?

On examination, your physiotherapist will look for signs of ligament injury. There will be tenderness over the ligament site, possible swelling and pain with stress tests. MRI may also be used to diagnose a knee ligament injury and look at other surrounding structures for combination injuries.

How Long does it take for an LCL Injury to Heal?

Treatment of an LCL injury varies depending on its severity and whether there are other combination injuries.

Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This plus exercises to strengthen your knees helps to prevent a future tear.

When a Grade II sprain occurs, use of a weight-bearing brace or some supportive taping is commonplace in early treatment. This support helps to ease the pain and avoid stretching of the healing knee ligament. After a grade II injury, you can usually return to activity once the joint is stable, and you are no longer having pain. The ligament healing may take a minimum of six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening, and joint exercises to guide the direction that the knee ligament fibres heal. This healing helps to prevent a future tear and quickly return you to your pre-injury status.

When a Grade III injury occurs, you usually wear a hinged knee brace for up to six weeks, with a small amount of movement, and use crutches for 1-2 weeks to protect the knee ligament from weight-bearing stresses. As your pain resolves and knee ligament repairing occurs, the knee brace can be gradually unlocked to allow additional knee movement as tolerated. The aim is to allow for full knee ligament healing and slowly return to normal activities. Severe LCL injury treatment via physiotherapy is a primary choice. However, we recommend the advice of a knee surgeon. Patients may not return to their full level of activity for 3 to 4 months. We highly recommend that you seek professional advice from a healthcare practitioner who specialises in knee ligament injuries to avoid long-term knee instability.

What is the Treatment for an LCL Injury?

Depending on the grade of knee ligament injury, you can start to feel better within days to just a few weeks of the damage. Your physiotherapy treatment will aim to:

  1. Reduce pain and inflammation.
  2. Normalise joint range of motion.
  3. Strengthen your knee: especially quadriceps (esp VMO) and hamstrings.
  4. Strengthen your lower limb: calves, hip and pelvis muscles.
  5. Improve patellofemoral (knee cap) alignment
  6. Normalise your muscle lengths
  7. Improve your proprioception, agility and balance
  8. Improve your technique and function, e.g. walking, running, squatting, hopping and landing.
  9. Guide your return to sport, activities and exercises.
  10. Minimise your chance of re-injury.

We strongly suggest that you discuss your specific knee rehabilitation plan with your trusted healthcare practitioner, after a thorough examination by a knee injury clinician such as a sports physiotherapist, sports physician or knee surgeon.

LCL Surgery

Most LCL injuries resolve well with conservative management. However, surgery may occur if there is significant ligament disruption, e.g. Grade III. Knee surgery may also be required if there is a considerable combination of injuries involving the ACL, posterolateral corner or meniscus. In these cases, the opinions of your knee surgeon, physiotherapist and doctor will guide the need for knee surgery.

Risks of knee surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications post-surgery.

Post-Ligament Repair

Post-operative knee rehabilitation is one of the most important aspects of knee surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced sports physiotherapist.

Your physiotherapy rehabilitation following knee surgery focuses on restoring full knee motion, strength, power and endurance. You’ll also require balance, proprioception and agility retraining individualised towards your specific sporting or functional needs.

As mentioned earlier, your sports physiotherapist is an expert in this field. We suggest you contact them for the best advice in your circumstance ces.

Your physiotherapist will guide your return to sport. It is highly variable and depends upon on your specific knee ligament injury and the demands of your competition.

How to Prevent Recurrence of LCL Injury?

A knee strengthening, agility and proprioceptive training program is the best way to reduce your chance of a knee ligament sprain. Premature return to high-risk activities such as sport carries risk. Please discuss with your physiotherapist or surgeon.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice.  Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.

ACL Tear

An ACL (Anterior Cruciate Ligament) tear most often occurs during sporting activities when an athlete suddenly pivots, causing excessive rotational forces on the ligament. Individuals who experience ACL tears describe a feeling of the joint giving out, or buckling. You'll commonly hear a "pop."

Signs You May Have Sustained an ACL Tear:

  • Sudden giving way of the knee
  • Hearing a 'pop' at the time of injury
  • Sudden swelling of the knee joint
  • Pain in the knee when walking

How is an ACL Tear Diagnosed?

A well trained Sports Physiotherapist, Sports Physician or Orthopaedic Surgeon will generally be able to confirm the diagnosis of an ACL tear within the clinic and from your injury history. An MRI scan can confirm your ACL tear and identify other knee injuries that may have occurred when your ACL was ruptured. These accessory injuries commonly include meniscal tears, bone bruising and collateral ligament injuries. Confirmation of an ACL tear is essential since the treatment differs from a common knee ligament strain or a meniscus tear.

What to do if have a Ruptured ACL?

Please be guided by your trusted healthcare practitioner for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury. For specific advice, please consult your physiotherapist, knee surgeon or doctor.

Why are ACL Tears Such a Big Problem?

When an ACL injury occurs, the knee becomes less stable. The ACL injury is a problem because this instability can make sudden, pivoting movements difficult, and it may make the knee more prone to developing arthritis and cartilage tears. If your knee is unstable, a common complaint of a sensation that the knee will 'give out' from under them. When this giving way sensation is because of an ACL injury, the knee joint is sliding too much. Joint sliding can be a problem because each episode of instability (the 'giving way' sensation) can cause damage to the knee cartilage. Therefore an ACL injury makes patients more prone to developing arthritis and meniscus tears. Athletes often have particular difficulty once they have sustained an ACL injury. Many sports require a functioning ACL to perform common manoeuvres such as cutting, pivoting, and sudden turns. These high demand sports include, but are not limited to:
  • Football
  • Soccer
  • Basketball
  • Skiing
  • Gymnastics
  • Hockey (Ice and Field)
  • Wrestling
  • Lacrosse
  • Rugby
Patients may be able to function in their normal daily activities without a normal ACL, but these high-demand sports may prove difficult. Therefore, athletes are often faced with the decision to undergo surgery in order to return to their previous level of competition.

ACL Tear? Things to Consider.

Patients who suspect they have an ACL tear should seek a professional assessment by their physiotherapist or sports doctor. An ACL tear may be misdiagnosed immediately after the injury because of associated pain and swelling. There may also be muscle spasm that contributes to making the knee challenging to examine. Therefore, it may not be possible to conclusively determine the presence of an ACL tear soon after the injury. If an ACL tear is suspected, you will return for a follow-up evaluation with your orthopaedic surgeon.

How Does Your Physiotherapist Make the Diagnosis of an ACL Tear?

The presence of a suspected ACL tear occurs whenever a patient has an injury to their knee. In the clinic, knee instability assessment occurs via specific manoeuvers performed by your physiotherapist or doctor. These manoeuvers test the function of the ligament to determine if an ACL tear is present. The most commonly used tests to determine the presence of an ACL tear include the Lachman Test and the Pivot Shift Test.

What are Other Tests Recommended to Diagnose an ACL Tear?

A complete examination of the knee is also necessary to determine if other injuries may have occurred that could be causing your symptoms. Your physiotherapist or doctor will also evaluate X-rays of the knee to assess for any possible fractures, and an MRI may evaluate ligament or cartilage damage. However, MRI studies may not be needed to diagnose an ACL tear. The physical examination and history are just as good as an MRI in diagnosing an ACL tear. Many patients are concerned when their doctor or physiotherapist does not order an MRI. While the MRI may be necessary in some cases, it is not required to diagnose most ACL tears, if there are laxity and a predisposing mechanism of injury.

What to do if have a Ruptured ACL?

We recommend professional guidance for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury.
The Anterior Cruciate Ligament (ACL) is the primary restraint to forward motion of the shin bone (tibia). The anatomy of the knee joint is critical to understanding this relationship. Mostly, the femur (thigh bone) sits on top of the tibia (shin bone), and the knee joint allows movement at the junction of these bones. Without ligaments to stabilise the knee, the joint would be unstable and prone to dislocation. The ACL prevents the tibia from sliding too far forward. The ACL also contributes stability to other movements at the joint, including the angulation and rotation at the knee joint. The ACL performs these functions by attaching to the femur on one end to the tibia at the other. The other major ligaments of the knee are the posterior cruciate ligament (PCL), and the medial and lateral collateral ligaments (MCL and LCL, respectively).

ACL Surgery

The decision as to whether or not to operate on an ACL tear is dependent on several factors. Some patients who experience ACL tears can resume normal daily activities without surgical reconstruction of this ligament. There are some important factors to consider in deciding as to whether or not operative treatment of an ACL tear is needed. These factors include the age of the patient, the activity level of the patient (both recreational and occupational), the expectations of the patient, the ability and willingness of the patient to undertake postoperative rehabilitation. Plus, the degree of instability of the joint, and any other associated injuries to the knee (e.g. other ligamentous or meniscal problems).

What is the Surgical Treatment for ACL Reconstruction?

ACL reconstruction is usually not performed until several weeks after the injury. Studies have shown improved results when ACL reconstruction surgery is delayed several weeks from the time of injury. This time allows the inflamed and irritated knee to cool down. Swelling decreases, inflammation subsides, and range of motion improves. Resolution of swelling and stiffness before ACL reconstruction surgery improves the postoperative function of the joint.

Can the ACL be Repaired?

ACL reconstruction surgery is common, and improperly, referred to as an ACL repair. Unfortunately, a torn ACL cannot be "repaired." Rather, the torn ligament's replacement is healthy graft tissue. It is not possible to repair the torn ACL by simply reconnecting the torn ends.

How is the ACL Reconstruction Performed?

The surgical procedure for an ACL reconstruction is variable but commonly involves using a segment of another larger ligament or tendon to replace the damaged ACL. The graft options for ACL reconstruction include: Hamstring Tendons Patellar Ligament Peroneus longus tendon Allograft (Donor Tissue) The ACL reconstruction surgery lasts about 1 1/2 to 2 hours, depending on the graft choice and any other work that may need to be done in the knee joint. Your physiotherapist will coordinate your postoperative rehabilitation and guidance.

What to do if have a Ruptured ACL?

We highly recommend professional medical for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury.

ACL Reconstruction Rehabilitation

sports-injury-physio-brisbane Post-operative rehabilitation is probably the least emphasized and most crucial aspect of care for a torn ACL. Whether or not a patient is diligent about their therapy determines how well their knee will perform after ACL reconstruction. Most patients experience a full recovery and resume their previous lifestyle, including professional athletes. However, some patients complain of pain, stiffness and limited motion in the joint for months or years following ACL reconstruction surgery. The best outcome is when your physiotherapist guides your rehabilitation in ACL Reconstructions.

What is the Timeline for Return to Activities after ACL Reconstruction?

Initially, following ACL reconstruction, patients can expect to be using crutches from one to three weeks. Early in rehabilitation, the emphasis is to control of swelling, the flexibility of the joint, and return of strength. As the range of motion improves, an increased focus is on recovering strength. Swimming and cycling are excellent methods of strengthening the muscles around the knee. Muscle strengthening is critical not only to recover muscle mass lost due to surgery but also to improve the stability of the joint as increased muscle strength reduces stress on the joint ligaments. Finally, regular (not high-demand) activities (e.g. running) can resume at about four months in most cases following surgery. Most athletes in high-demand sports with cutting and lateral movement (e.g. soccer, basketball), can expect to return about six to twelve months after surgical reconstruction. Over 90% of patients can resume their previous level of activity after ACL reconstruction. A small percentage of patients m persistent pain or instability; however, changes in activity level following ACL reconstruction surgery are often due to choice rather than limitations of the knee joint.

What to do if have a Ruptured ACL?

We highly recommend physiotherapy guidance for any ACL tear. Successful rehabilitation options vary depending on your age, activity level, the extent of injury what sporting demands that you are planning to resume.

ACL Insufficiency Knee Braces

ACL injuries may be less noticeable via a supportive brace. The severity of the injury and rehabilitation stage will determine which is the most suitable ACL brace.

What to do if have a Ruptured ACL?

We highly recommend professional physiotherapist or knee surgeon guidance for any ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury.
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