What is LCL Tear?
Knee is one of the most complicate and sensitive joints in the body. In order to provide stability and support to the knee, there are four important ligaments. Among them is lateral collateral ligament, which is made of tough fibrous bands that runs along the outside of the knee.
LCL is locate at outer side of the knee, which connect femur (thigh bone) to outer side of tibia (shin bone). The main function of LCL is quite similar to that of MCL i.e. to provide stability and support to knee joint. LCL is also known as fibular collateral ligament. LCL prevents the knee from excessive twisting and sideway movements.
LCL is torn when knee receive sudden and direct blow to the inner side of the knee. Generally, this inner part of knee is safe and secure because the opposite leg protects it from any harm. Therefore, 25% of LCL injuries are occurred due to meniscus injury. Pain and swelling can be felt at the inner side of the knee.
Types of LCL Tear:
LCL injury occurs very rarely and the pain differs according to the grade of injury. Doctors graded LCL tear as follows:
LCL Grade 1 Tear – Minor sprain or partial tear of PCL. The ligament is mildly stretched and the knee joint is still stable. Small number of fibres are torn. No loss of function.
LCL Grade 2 Tear – Major sprain or incomplete tear of PCL. The ligament loosens and partially torn. Significant number of fibres are torn. Moderate loss of function.
LCL Grade 3 Tear – Severe sprain and complete tear. Even, the knee joint becomes unstable and shaky. All the fibres are ruptured. Severe loss of function. Menisci or curciate ligament is also damaged.
What are the Symptoms of LCL Tear?
Patients suffering from LCL tear often complain about the sudden onset of pain due to injury. Some of the symptoms associated with LCL tear are:
- Severe pain at inner side of knee.
- Audible knee popping or tearing can be felt at time of injury.
- Failure to bear body weight on injured leg.
- Swelling and inflammation.
- Tenderness will also developed at the point of injury.
- Knee will become stiff and tight.
- Patient will be unable to straight and bend the knee.
- Instability can be experienced when trying to extend the knee.
- Difficulty and discomfort while ascending and descending stairs
- Knee joint will become weak and unstable.
- Knee locking or catching sensation.
- Bruising can be visible after 1-2 days.
What are the Causes of LCL Tear?
Many individuals injures their LCL due to following causes.
- Direct blow to the inside part of the knee.
- Hyperextension of knee beyond it limits.
- External tibial rotation.
- Excessive varus stress.
- Sudden twisting motion, when foot is firmly planted on the ground.
- Improper techniques in sports.
- Traumatic injuries.
- Overuse injuries.
- Repetitive stress on knee joint.
Diagnosis of LCL Tear:
Doctors analyze the knee and check for pain and swelling in the knee joint. Knee will bent and straighten with pressure with the aim of accurately determining the injury. They will also ask about your activities and cause of injury.
MRI clearly shows the pictures of the damaged tissues making viable for doctors to evaluate the injury. X-ray is also necessary to know whether any loose fragment of bone is present in the knee joint. It is also beneficial in ruling out any further complications such as menisci or ligament injuries.
Treatment of LCL Tear:
The treatment method for LCL injury generally depends on the grade of injury. The chief component to effective treatment is controlling pain and swelling so as to evaluate the accurate type of grade at the early stages of injury. This will help in choosing better and effective treatment. Some of the common PCL tear treatment are as follows:
- R.I.C.E.: This formula is used in the initials days of injury. The acronym stands for protect, rest, ice, compress and elevate.
- Protect: The basic mantra is to protect your knee from further complications. Already, you knee joint is unstable so it is wise to avoid aggravating activities that can result in severe tear.
- Rest: Resting allows the pain to calm down and helps in the treatment.
- Ice: This step is crucial in the treatment because it will reduce the pain and swelling. The method is to apply ice-pack at the point of injury for 15-20 minutes. You can apply several times a day with a gap or couple of hours or so. Avoid applying ice directly to the point of injury because it will damage the soft tissues. Use ice-pack or ice wrapped in towel.
- Compress: Compressing the injured are with using elastic bandages will limit the pain and swelling. Avoid wearing the bandage tightly. Remove it occasionally otherwise the lower leg will become numb.
- Elevate: Raise your leg above heart’s level so that the blood flow is limited to the knee joint otherwise the swelling will increase.
- Splinting: The technique of splinting technique helps knee from further injury and provide significant relief to the patient. You can use ready-to-wear splints.
- Crutches: Using crutches while walking will help the knee to keep off putting unnecessary weight on your injured leg. Use crutch until you walk properly without any limp.
- Knee Brace: Bracing will prevent further injuries and keeps the knee safe. They will stabilizes and support the knee. They are extremely effective in controlling sideways movement of knees and saves the knee from unusual movements.
- NSAIDs: These medications control the swelling and inflammation. However, consult your doctor before diagnosing any anti-inflammatory medication.
- Physical Therapy & Rehabilitation: Consult a physical therapist once the swelling and pain is reduced. They will formulate a specific and individualized exercise program that will improve the strength and provide stability in knee joint and muscles. Some of the exercises to regain strength and mobility in the knee joint are – Quadriceps sets, hip flexes, hip abduction & adduction., static quads contractions, calf raises, isometric hamstring contractions, knee extension exercise, seated hamstring curl, bridge exercises, single leg bridges , half squats, half squats, lunges, balance board exercises, wobble board exercises, box jumps, plyometrics or plyometric exercises.
- Soft Tissue Massage: Massage therapy is also vital in rehabilitation program. They helps alleviates pain, increase relaxation and flow of blood. Some massages are soft tissue mobilization to anterior knee and incisions, patellar mobilizations and quad strengthening.
- Taping: It will help the ligaments from any further injury. Taping is also beneficial when resuming normal activities after successful recovery.
- Education: Athletes should properly learn sports technique and methods in the coaching or experts. This will prevent them from injuries and succeed in their career.
- Activity Modification: Modify regular activities will greatly influence and improve the overall quality of health.
- Surgery: Surgery is required in severe injuries or third grade injuries. Since LCL tear is often accompanied with meniscus or ligament injury, treatment differ according to the injury. Surgery often involves stitching LCL tear or reconstructing the ligament with healthy part if tendon such as hamstring tendon.
Recovery Period for LCL Tear:
Recovery mainly depends on the type of method used in treating PCL tear. The grade I of LCL Tear requires couple of weeks to one month for complete recovery. The grade 2 of LCL Tear requires 3 weeks to 6 weeks for total recovery. Grade III of LCL injuries may require 8-12 weeks or more to heal.
Conclusion – LCL Tear:
The outlook is good and patients can resume their normal activities once the PCL tear is healed. Isolated LCL tear is good for treatment. Otherwise, the treatment will take more time for rehabilitation for other injuries often associated with LCL tear like cartilage tear or meniscus tear.