A lateral ligament sprain is a knee injury involving a tear to the ligament on the outside of the knee. It most likely occurs following a direct blow to the inside of the knee, which causes overstretching of the knee. Here we explain the treatment, rehabilitation, and exercises, as well as strapping and taping to return you back to full fitness.
On this page:
- Symptoms & diagnosis
- Causes & anatomy
- Sports massage
- Strapping & taping
Symptoms of an LCL sprain
Symptoms of a lateral collateral ligament sprain or LCL for short can vary from being very mild to a complete rupture of the ligament. Lateral ligament sprains are categorized into grade 1, grade 2 or grade 3 sprains depending on the extent of the injury.
Grade 1 lateral ligament sprain symptoms include tenderness on the outside of the knee over the ligament. Usually, there will be little or no swelling. When the knee is bent to 30 degrees and force applied to the inside of the knee which puts the ligament under stress, pain is felt but there is no joint laxity.
Grade 2 knee ligament injury symptoms consist of significant tenderness on the outside of the knee over the lateral ligament. Some swelling can be seen over the ligament. When the knee is stressed as for grade 1 symptoms, there is pain and some laxity in the joint, although there is a definite endpoint indicating the ligament is still intact. In other words, the knee cannot be bent sideways completely.
Grade 3 lateral ligament sprain is a complete tear of the ligament. Pain can vary and may be actually less than a grade 2 sprain. When stressing the knee there is significant joint laxity. The athlete may complain of having a very unstable knee.
Assessment & diagnosis of LCL sprains
The varus stress test is used to help diagnose injury to the lateral knee ligament by putting it under stress or tension. The therapist takes hold of the limb, ensuring the knee is slightly bent (approx 30 degrees). They stabilize the thigh whilst applying inward pressure on the lower leg. This stretches the lateral ligament. Pain on the outside of the knee indicates a positive test. The degree of damage can be determined by how much movement/instability is present.
Lateral knee ligament sprain causes & anatomy
The lateral ligament or lateral collateral ligament or LCL for short connects the femur or thigh bone to the top of the fibula bone in the lower leg. The ligament itself is a narrow strong cord of collagen fibres and its function is to provide stability to the outside of the knee.
The ligament is most commonly injured in sports by a direct impact to the inner surface of the knee joint, such as by a rugby or a football tackle. A lateral ligament sprain is less common than those affecting the medial collateral ligament which commonly occurs as a result of trauma to the outside of the knee.
The ligament is not connected to the lateral meniscus in the joint and so unlike medial ligament injuries, they are not normally associated with meniscal tears. However, injury to the anterior cruciate ligament or posterior cruciate ligaments can occur at the same time as a lateral ligament sprain. A full examination once any pain and swelling have gone down is required.
Treatment of a lateral knee ligament injury
Treatment is similar for all knee ligament injuries.
What can the athlete do?
Immediately following an acute injury, or if there is swelling apply the PRICE principles (Protection, Rest, Ice, Compression, Elevation). Rest may mean complete rest or for a longer term, chronic injuries discontinue the sport or activity that irritates the injury or causes pain. Wear a hinged knee brace to support and protect the joint, particularly for grade 2 and 3 injuries. A hinged knee brace will have solid metal supports at the sides to protect the knee from a lateral (sideways) movement which would stress the lateral knee ligament.
What can a sports injury professional do?
The initial aim of a health professional will be to assess the extent of the injury and obtain an accurate diagnosis. In more serious cases an MRI scan and/or X-Ray may be necessary. Depending on the severity of the injury a number of treatment options are presented to the clinician.
In grade 1 & 2 tears, conservative methods of treatment are usually preferred. These may need to be carried out for up to 8 weeks and may include ultrasound or laser treatment, prescription of NSAID's (e.g. Ibuprofen), use of manual techniques such as massage and on a full rehabilitation program, which may include strengthening and proprioceptive and balance exercises.
Sports massage may help the healing of a lateral ligament injury when applied directly to the ligament in the form of cross friction massage. This may help to reduce scar tissue formation and re-align the new healing fibers with the ligament. Before starting any massage treatment the therapist will check for contraindications (if any apply to you, then massage is not allowed).
Cross friction massage must not be performed during the acute stage of this injury - usually 48-72 hours after injury. For grade two and three strains, massage may not be suitable for over a week. This is because if the is still bleeding then heat and massage will increase bleeding, not stop it. Sports massage techniques can also be applied to the quadriceps and hamstring muscles in order to reduce swelling and relax tight muscles to improve flexibility.
Aim to gradually apply firmer frictions to reduce adhesions and aid healing. With a finger, apply frictions backwards and forwards across the ligament as shown opposite. The therapist may apply frictions to the ligament at the point of the joint line, trying to identify specifically the injured area by feeling and judging the response from the athlete. Start gently and slightly away from the tendon attachment, gradually working towards the attachment and getting deeper as the athlete becomes accustomed to massage.
Lateral knee ligament taping
Support taping (play video) for the lateral ligaments can help with protection, not just during treatment and rehabilitation phase, but when returning to normal training.
Anchors are applied above and below the knee where support strips which follow the line of the ligament are applied. The knee is placed in a relaxed position bent to about 30 degrees. Anchors are applied above and below the knee with elastic tape to ensure when the muscles expand during exercise blood flow is not restriced.
Support strips are then placed along the side of the knee with non stretch zinc oxide sports tape in a cross formation. These provide the support for protecting the lateral ligaments from excess stress.
Surgery for LCL sprains
In grade 3 sprains, particularly when other structures such as an ACL tear or PCL tear are damaged, surgery may be needed to prevent future instability. This may involve suturing or stitching the torn ends of the LCL or reconstructing the ligament with a part of a tendon e.g. hamstrings tendon.
Recovery from these injuries is a lot slower than conservative methods and it may be a number of months before the athlete is able to return to sports.