CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Lateral Collateral Ligament Injury
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Injuries and Conditions: Lateral Collateral Ligament Injury : Lateral Collateral Ligament Injury : Treatment Options
 

Overview
A damaged LCL will not necessarily require surgery for a full recovery. Differences in the severity of the injury will affect the treatment decision. LCL injuries range from minor sprains to complete tears of the ligament. Minor injuries can be treated non-surgically based on the symptoms present. Severe injuries including complete tears require early surgical intervention to achieve an optimal outcome.

Treatment options:

Conservative Treatment of LCL Overview

Physical therapy is designed to restore strength, stability and range of motion through exercises, stretching and muscle stimulation.

  • The initial goal of therapy is to re-establish a full range of motion in the knee.
  • Ongoing therapy rehabilitates the quadriceps and hamstrings, the surrounding muscles which add strength and control to the joint.
  • Partial or complete tears will require bracing to provide stability to the inner aspect of the knee while the ligament heals.

    Rehabilitation Program
    Patients with mild LCL injuries that are stable with inner knee stress testing are generally treated based on their symptoms, without the use of a brace.

    Rehabilitation focuses on regaining knee range of motion and quadricep/ hamstring strength.

    Patients with moderate to severe instabity during knee stress testing are treated with a brace for 4-6 weeks. This brace is typically hinged to allow a range of motion from 0-90 degrees. Crutches are used until the patient can fully extend the knee and can walk normally without them.

    Range of motion exercises are started early, initially in a pain free arc. Once range of motion is restored hamstring and quadricep strengthening is begun.

    With severe injuries in patients involved in contact sports, such as football, a functional knee brace may be helpful to prevent re-injury when they return to sports.

    Medication and Medical Products
    Knee: Compression SleevesKnee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.


  • Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella

  • Knee BracesKnee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.

    Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.

    Knee braces can be used to treat:

  • Pre-operative ACL/PCL ruptures or injuries
  • Non-surgical ACL/PCL injuries
  • General knee instability
  • Pre/post joint replacement with ligament instability
  • Grade II or III ligament sprains.

  • Long-Term Expectations for Recovery

  • Patients with more minor injuries can expect to fully recover within 2-4 weeks, especially if physical therapy is undertaken.
  • Patients suffering severe injuries that have resulted in the partial tearing of the LCL will require much longer to rehabilitate, although a full recovery is still possible with intensive physical therapy. These injuries may heal over three or more months.
  • A patient who is considered fully recovered may participate in athletic activities at their pre-injury level.
  • Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent further injury to the knee. In some cases this will mean completely forgoing certain activities that place particular stress on the knee.
  • Recovery is more dependent on the condition of the joint before and after injury, and how the internal structures have been repaired, than on the number of days, weeks or months since the injury occurred.

    Possible Complications and Risks

  • Risks are minimal and complications are rare.
  • The most common major complication is re-injury of the LCL, especially in contact sports.
  • Residual laxity(looseness)may develop in patients with moderate to severe injuries that are not braced long enough for the ligament to heal properly. If the laxity limits activity and cannot be corrected with functional knee bracing, surgery may be necessary.
  • Stiffness can develop if patients are immobilized after the injury and if gentle range of motion is not started early.

    Surgical Hardware Considerations

    This condition does not require surgical hardware.


    Factors in Transplant Source
    A ligament augmentation of a chronic LCL tear is often needed when the ligament is dengenerated or irrepairable. A tendon graft from the healthy knee or a transplant tendon is often used. This tendon graft is attached with a staple and/or screw.