LATERAL COLLATERAL INJURY LIGAMENT

Lateral Collateral ligament is important part of lateral supporting complex. It gives stability against varus overload. Whenever , the adduction stress goes over the physiological limits, the ligament ruptures. The injury can occur in spots , accidents and falls.
Mechanism of injury
Violent adduction force is the main mechanism of injury. Other ligaments get injured depending on position of knee.

Clinical features
During acute episode, there is giving away of knee. A click or pop is often heard. There is pain and disability.
After the acute episode subsides , patient complains of giving away.
Signs
There will be localised tenderness at collateral ligament. Sometimes a defect is felt . Incomplete extension is a common feature of chronic painful knee.
There might be associated quadriceps atrophy.

Adduction (varus) stress test.
Knee is flexed at 30 degrees. Stabilise thigh and adduct leg. Look for pain and opening up. Grade of opening up denotes, the grade of instability.
When knee is stressed in extension, intact cruciates are tout and hence instability is not detectable.

Appley’s compression distraction test
Patient lies prone. Knee is flexed at ninety degrees. Thigh is stabilised and foot is grasped. Traction is given on foot. Pain suggests injury to ligamentous complex. In second step, compressive force is given. Simultaneously foot is rotated. Pain suggests meniscal injury.

Triple varus knee
Triple varus knee is long term consequence of LCL injury, if associated with cruciate injury. The entity is characterised by genu varum, varus instability and varus thrust in stance phase.


Investigations
Radiograph are usually negative. Sometimes, a small avulsion fragment can be seen. Stress views can be done to see opening up of joint line.
MRI shows clear and accurate images.

Management
Initial management of acute injuries is with RICE.

R rest
I immobilisation
C cryotherapy
E elevation

First degree sprains usually respond to extended first line regime. Second degree sprains require protection with cast or with hinged braces. Mobilisation with graduated exercises is done after 6 weeks.
Third degree sprains especially associated with associated injuries are treated surgically.
Primary repair is done for third degrees sprains and avulsion injuries.
Reconstruction is done for chronic instabilities associated with high activity demands.

Every repair or reconstruction should be followed by physiotherapy protocol.
Click on this link for further information about NECESSARY PHYSIO.