Knee LCL

The most common cause of this injury is direct impact or blow to the medial (inside) of the knee causing a sudden gapping force on the outside of the knee.

• The lateral collateral ligament (LCL) can become strained, stretched or torn
• The greater the force, the more severe the ligament injury
• The lateral collateral ligament (LCL) is not attached to the lateral meniscus so damage to it is not associated with a meniscal tear
• Significant LCL damage can be associated with injury to the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL)

In response to this type of injury one should initiate the RICE protocol of Rest, Ice, Compression, and Elevation in addition to the following:

• Rest to avoid aggravating the injured knee and ligament through excessive activity.
• Immobilization to keep the ligament from being stressed any further and promote healing in the correct position. Depending on the severity of the injury the knee may be immobilized for a period of time.
• Ice to reduce inflammation and pain for the first 48-72 hours. Do not apply directly over skin and use ice intermittently during the day. Apply the ice for 20 minutes at a time. Do not apply any form of heat during this period.
• Contact your physician medical provider for complete diagnostic evaluation of the injury and follow up care.
• Physical Therapy may be indicated to treat and rehabilitate this injury for Grade I-III injuries.
• Grade III injuries may require repair of the lateral collateral ligament.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client.

Initial treatment will be focused on protecting the ligament, reducing pain and swelling, as well as restoring motion. As the physical therapy program progresses, strengthening, flexibility, and aerobic exercises, in addition to technique and proprioceptive training to protect the knee and ligament will be added in an effort to restore normal activity level.

Grade I-II injuries may start off with immobilization to protect the ligament and joint. Physical therapy will be progressed based on the individual’s symptoms, with the removal of the immobilizing device and initiation of a stretching, strength and functional rehabilitation program.

Grade III injuries may require surgery, especially if other structures (like the ACL or PCL) are involved. Repair or tightening of the ligament may be necessary. Physical therapy will focus on restoring motion, strength and function based on the physician’s post-operative protocol. Full return to activity will depend on:

• Restoration of pain free full range of motion
• Patient ambulating independently without a limp
• Objective quadriceps strength in the 90% range

Common physical therapy interventions for this condition include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the knee.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strength to protect and stabilize the knee and affected ligament.
• Neuromuscular Reeducation (NMR) to restore stability, begin retraining the lower extremity chain and improve movement technique and mechanics (running, jumping and cutting) in use of the involved knee in daily activities.
• Modalities that can include use of ultrasound, electrical stimulation, ultrasound, ice, cold laser and others to decrease pain and inflammation at the knee and ligament.
• Home program includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Following an injury to the lateral collateral ligament one should seek a full evaluation from a physician or health care provider. Treatment may consist of the following:

• Clinical evaluation including a physical exam, X-rays and MRI in more severe Grade III and Grade IV injury
• Use of ice and immobilization to stabilize and rest the joint
• Anti-inflammatory medication and pain medication as needed
• Progression to a hinged brace if indicated
• Referral to physical therapy to progress rehabilitation following a period of immobilization.
• Surgery may be indicated in Grade III-Grade IV injuries or cases involving damage to other knee structures (like the ACL or PCL) secondary to rotatory instability.