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The knee can be thought of as a major junction in our musculoskeletal system. Three bones meet at the knee: your thigh bone, shin bone and kneecap. They’re all held together with the equivalent of straps - the four knee ligaments. Inside the knee, there are two cruciate ligaments in the shape of the letter X. Then there is the ligament we’re going to look at here: the lateral collateral ligament (LCL). There are two of these, both running the length of the knee - one on the inner leg side of the knee and one on the outer leg side.
Ligaments have to be sturdy because they hold the knee together, even when you’re twisting and turning while taking part in a strenuous sports session. When you need to stand or sit, they also have to keep the knee stable, so they are tough bands of connective tissue strapping the knee together. That’s why you may find braces useful if you have an injury. They replicate the strapping and stability functions of the natural knee while allowing some movement.
Figures for how many people suffer from lateral collateral ligament injuries in a year aren’t readily available, partly because those with mild problems don’t seek out medical help. The NHS estimates that each year, 10,000 people in the UK have cartilage damage that is troubling enough to take them to the doctor. However, anecdotal evidence from sports injury clinics and physiotherapists suggests that knee injuries in general are extremely common.
Accidental damage to the lateral collateral ligament is more common in people under 35 because they are more likely to be playing sports. One Yorkshire NHS hospital says that LCL injury is less common than some other knee injuries and that they are more often linked to a significant trauma to the knee or force being applied to the inside of the thigh or knee. It’s clear that contact sports such as football or rugby, where players can get kicked during tackles, are prime candidates for picking up LCL injuries caused by trauma - in this case, the force of the kick.
Damage to the LCL is graded into three levels:
The options available for treating the injury will depend on the degree of the injury and other factors such as your age and occupation.
The knee will be tender when pressed, especially on the outer side, and it may be swollen. You will have trouble standing on it.
Some people with mild damage decide to give the PRICE treatment a go before they seek professional assistance:
Pain relief can help, especially at night when turning over in bed may cause additional pain. Paracetamol is safe for most people, but don’t exceed the stated dose in any 24 hours. Tablets containing ibuprofen have an anti-inflammatory effect whilst reducing pain, so they’re a good choice for this type of injury. There are now also a number of creams and gels on the market that are specifically aimed at this type of injury. The pharmacist at your local chemist will be able to point you towards the most suitable one for you and offer advice on how long you should continue to use it.
Some doctors suggest that in addition to the PRICE regimen, you use a lightweight brace that will allow your knee to make backwards and forwards movements but not side-to-side ones. If that works, you can see the physiotherapist for advice on exercises to help rehabilitate the knee.
The symptoms may include those for the first-degree injuries, such as pain and swelling, but with more intensity and affecting the inner side of the knee. The knee is noticeably loose when you move it by hand because the strapping that the ligament would normally provide is damaged.
Treatment will depend on the extent of the injury. In this case, you must seek professional help. It can be difficult for doctors to find out the precise extent of the damage because the swelling and the patient’s pain may make it difficult to examine the knee. If they suspect a serious injury, they may wish to carry out further investigations such as an MRI scan or X-ray.
With these kinds of injuries, the force that produced them may also have damaged other structures in the knee, such as the anterior cruciate ligament and this can also complicate diagnosis.
You will experience marked tenderness and pain on the inner side of your knee. There will be swelling, and the knee joint will not be stable. If you remember the three bones mentioned at the start of this piece, the LCL may have been torn at the point where it meets the thighbone or at the other end where it connects with the shinbone.
The surgical procedure for an LCL injury that has resulted in rupture will involve reattaching the LCL to the bone it has come away from. However, sometimes the tear is in the middle of the LCL; in other words, it has been torn into two pieces. In these cases, the surgery will involve stitching the torn ends together again.
In the worst cases, a repair may not be possible. The surgeon may have to take some tendon from another part of your body or use donor tissue to construct a replacement, which is a more complex procedure.
Some of these procedures can be carried out as keyhole surgery. It depends on the complexity and specific features of your injury. Open knee surgery may be necessary in more complex cases.
How long it takes to get back to normal will depend on the grade of your injury and whether you have had surgery. Rehabilitation can take anywhere from one to eight weeks or even longer if you have a very complicated full rupture and other accompanying damage.
Making full use of braces, splints and walking aids may help your rehabilitation, as will exercises prescribed by a physiotherapist. Just be careful not to overstress the ligament, and don’t return to sporting activity until you’ve regained full fitness.