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The LCL is the lateral collateral ligament of the knee. It is made of strong collagen fibres that prevent the outward movement of the knee, known as varus. The LCL can be injured if this varus movement is forced and the ligament is stretched beyond its capacity. In this scenario, some of the collagen fibres are torn, and the function of the ligament can be impacted. The extent of the injury will determine how functionally impaired the ligament will be. Injury to the LCL is graded from 1-3, with grade 1 a minor injury and grade 3 a complete rupture.
LCL injuries are relatively rare. This study found that of all knee injuries in the sporting population only 1% were to the LCL (Majewski et al, 2006). The knee is more likely to be injured by excessive inward force, damaging the MCL (medial collateral ligament) than with lateral movement.
In many cases, the LCL is injured along with another ligament such as the ACL or PCL, or when the knee is dislocated. It can also be damaged with a meniscus injury.
A ligament injury in most cases will occur with a specific injury. For an LCL to tear the knee must be forcefully moved beyond its normal range of movement laterally, and at that moment there will be pain as the structure is damaged.
Subsequently, the knee will swell. Swelling can vary from person to person, but in most cases, the severity of swelling is relative to the damage. In high-grade injuries, the ligament’s function of providing knee stability will be impaired so a feeling of instability is common with these injuries. In severe cases of rupture or near rupture, the knee may buckle or give way.
An assessment and physical examination with a sports doctor or physiotherapist will confirm or correct your suspicions of an LCL injury.
Walking can be painful during the acute phase of any LCL injury. In a grade 1 LCL injury, walking after the initial few days or week, can be helpful to keep mobility in the knee. Some people find it more comfortable to wear some elasticated tape like Kinesio tape, or wearing a compression sleeve.
With a grade 2 or 3 injuries, more time completely resting the knee after the injury may be needed. And when returning to walking more support can be helpful, such as rigid tape or a structured, hinged brace.
Read more about recommended braces in our related article: Knee Brace for LCL Injury.
Returning to running after sustaining an LCL injury needs to be carefully managed. With the guidance of an experienced sports physical therapist, you will be able to determine the correct timing and way to return to running.
Grade 1 LCL tears may be able to return to running after 2-3 weeks depending on their symptoms, strength and conditioning.
While with grade 2 or 3 injuries it may take more than 6 weeks before it is appropriate to return to running. In these cases, very good strength and conditioning and good movement control is necessary to ensure no further stress or damage to the LCL ocurrs.
Strength and conditioning for the muscles surrounding the knee to improve general strength and flexibility is the best approach to reduce stress on the LCL. Specifically working on quadriceps, adductors, hamstrings and abductors (glutes) is very beneficial.
It is not possible to specifically strengthen a ligament. However, allowing the ligament to heal in a short position, where it is not stretched will help reduce the laxity of the injured ligament. It will be stronger as a result.
The LCL is one of the 4 principle ligaments of the knee. The LCL prevents lateral movements (varus), the MCL prevents medial movements (valgus), the ACL prevents anterior translation of the tibia with the femur and the PCL prevents this movement posteriorly.
Each of the 4 ligaments also have additional roles with other movements. The LCL additionally prevents posterolateral rotation of the tibia on the femur.
The healing time of an LCL injury depends on the severity of the injury, but most heal within 3 to 12 weeks. A grade 1 tear may take 1-3 weeks, grade 2 4-6 weeks, and a grade 3 may take 12 weeks.
In some cases, a surgical option may be offered when conservative treatment has not been effective. Ligament reconstruction is often performed for a complete ligament rupture, but some high-grade tears can heal independently.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.