Lateral Collateral Ligament Sprain (LCL)

The lateral collateral ligaments are located on the outside part of the knee between the femur (thigh bone) and the tibia (shin bone). 

The LCL resist varus stress (forces pushing the inside of the knee outwards or forces pushing the lower end of the shin bone and foot inwards). It’s especially vulnerable when the knee is flexed (bent). A good example of this can be seen when a footballer gets kicked on the outside of the foot or leg. The LCL also restricts internal rotation of the lower leg (actions which turn the foot inwards). This why this ligament is vulnerable during skiing when the ski rotates towards the other foot it creates a significant torsion (twisting) force at the knee. The LCL, unlike the Medial collateral ligament is not attcehed to the knee meniscus (pad of cartilage between the thigh and shin bone).

Although relatively rare the LCL can also be injured by repetitive lower irritation. These are often more difficult for the patient to realise and can be as subtle as sitting in certain position or running on a sloped or soft surfaces such as beaches. A very important job of any manual therapist is to first prevent this mechanism of injury in order to allow the ligament to repair.

Diagnosis

The Bodymotion Chiropractors will take a thorough history from the patient which will often give a good indication as to which knee structures may be damaged. This will dictate the specific orthopaedic test preformed during the initial assessment. They will also examine the knee to see if there is any tenderness or swelling around the ligaments.

Ligaments sprains are graded as follows:

Grade I

• Able to fully weight bear through the knee with negative instability on varus stress test.
• No/mild swelling on the inside of the knee.
• Mild/moderate tenderness over ligament.
• Mild pain.

Grade II

• Able to weight bear through the knee positive instability varus stress test with slight increased movement.
• Mild to moderate swelling on the inside of the knee.
• Moderate/Marked tenderness over ligament.
• Moderate/severe to marked pain.

Grade III

• May be able to weight bear through the knee but aware of significant instability (feeling of giving way) with positive instability on varus stress test.
• Mild to moderate swelling on the inside of the knee.
• Moderate/marked tenderness over ligaments.
• Moderate/severe pain

Ligaments cannot be seen on xray and due to their close proximity to bone ultrasound imaging is often of little use in this region. Therefore MRI Scans tend to be utilised when assessing suspected severe ligamentous injuries.

Treatment

If there is any sign of instability on testing (giving way of the knee) this may suggest the ligament is not sprained but ruptured and would require referral for further assessment and possible surgical opinion.

Our city of London chiropractic clinic has an excellent medical team of specialist we can refer to in such instances with minimal disruption to our patient’s working week.