Lateral Collateral Ligament Injury of the Knee: Difference between revisions
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
The lateral collateral ligament is a structure of the arcuate ligament complex, together with the biceps femoris tendon, popliteus muscle and tendon, popliteal meniscal and popliteal fibular ligaments, oblique popliteal, arcuate and fabellofibular ligaments and lateral gastrocnemius muscle<ref name="[5]" /><sup>(A2)</sup>. The lateral collateral ligament is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with the function to resist varus stress on the knee and tibial external rotation and thus a stabilizer of the knee. When the knee is flexed to more than 30°, the LCL is loose. The ligament is strained when the knee is in extension.<ref name="[3]" /><ref name="[6]">Medscape reference. Drugs, Conditions & Procedures. http://emedicine.medscape.com/article/89819-overview#showall (accessed 4May 2011)</ref><ref name="[7]">eOrif. Lateral Collateral Ligament Tear. http://www.eorif.com/KneeLeg/LCL.html (accessed 8 May 2011)</ref><br> | The lateral collateral ligament is a structure of the arcuate ligament complex, together with the biceps femoris tendon, popliteus muscle and tendon, popliteal meniscal and popliteal fibular ligaments, oblique popliteal, arcuate and fabellofibular ligaments and lateral gastrocnemius muscle<ref name="[5]" /><sup>(A2)</sup>. The lateral collateral ligament is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with the function to resist varus stress on the knee and tibial external rotation and thus a stabilizer of the knee. When the knee is flexed to more than 30°, the LCL is loose. The ligament is strained when the knee is in extension.<ref name="[3]" /><ref name="[6]">Medscape reference. Drugs, Conditions &amp; Procedures. http://emedicine.medscape.com/article/89819-overview#showall (accessed 4May 2011)</ref><ref name="[7]">eOrif. Lateral Collateral Ligament Tear. http://www.eorif.com/KneeLeg/LCL.html (accessed 8 May 2011)</ref><br> | ||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
Revision as of 22:14, 27 May 2011
Original Editors - Wouter Claesen
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Search Strategy[edit | edit source]
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Key words: Lateral Collateral Ligament knee injury, Knee sprains, peroneal nerve injury, instability LCL injury, Instability knee lateral collateral ligament, Lateral collateral ligament injury definition, lateral collateral ligament injury examination, lateral collateral ligament injury etiology, lateral collateral ligament injury epidemiology, lateral collateral ligament injury characteristics.
Definition/Description[edit | edit source]
An injury to the lateral collateral ligament of the knee can be caused by a varus stress, lateral rotation of the knee when weight-bearing or when the LCL loses it’s elasticity caused by repeated stress [1][2][3][4].The LCL can be sprained (grade I), partially ruptured (grade II) or completely ruptured (grade III) [3]. Additional damage of the ACL, PCL and medial knee structures is possible when the lateral knee structures are injured [5](A2).
Clinically Relevant Anatomy[edit | edit source]
The lateral collateral ligament is a structure of the arcuate ligament complex, together with the biceps femoris tendon, popliteus muscle and tendon, popliteal meniscal and popliteal fibular ligaments, oblique popliteal, arcuate and fabellofibular ligaments and lateral gastrocnemius muscle[5](A2). The lateral collateral ligament is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with the function to resist varus stress on the knee and tibial external rotation and thus a stabilizer of the knee. When the knee is flexed to more than 30°, the LCL is loose. The ligament is strained when the knee is in extension.[3][6][7]
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
The observation will begin with the therapist observing the knee for swelling, bruising and deformity. [8] It is not expected that there should be a significant joint effusion within a few hours unless there also is a cruciate ligament or meniscal tear. It could also be important to determine whether the patient felt or heard a pop in the knee, as this may suggest an aforementioned injury. [9] Next one should proceed with a palpation around the joint, searching for areas of tenderness, warmth, swelling, etc. In the case of a trauma at the LCL palpating over the ligament will range from mild tenderness in grade one sprains, to acute pain in more serious injuries. The peroneal nerve can also be injured. This type of injury requires surgical repair because of the complex structures which are involved. Damage is easily spotted if you see a foot drop of the patient while he is walking. [10]
To determine the gravity and laxity of the knee the therapist can carry out a varustest. The patient has to be in a relaxed position and the knee is held in 30 degrees flexion. This to loosen the posterior capsule of the knee. Grade 1 sprains doesn’t show any laxity of the knee. Only pain is occurred. There is a noticeable laxity but still a demonstrable endpoint with grade 2 injuries. To determine whether it is a grade 2 sprain or 3, you can take the test in extension. When the patient has a severe grade 3 sprain, the knee will show laxity, while a grade 2 sprain won’t. Also the grade 3 sprain will not have a demonstrable endpoint at 30 degree flexion. [11]
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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When a patient suffers a direct impact to the inner surface of the knee joint, the therapist can automatically assume that the lateral collateral ligament is damaged because of an abnormal stretch of the ligament caused by the joint from gapping at the outer surface. There are different degrees of sprains. Grade 1 and 2 can be treated with proprioceptive exercises. However, manual techniques like massage, ultrasound , and, if necessary, anti-inflammatory medication can also be effective.
Grade 3 sprains are more severe, the anterior cruciate or posterior cruciate ligaments may also have become damaged. In this case surgery can be needed to prevent further instability of the knee joint. [12] Of course there would be a much longer revalidation needed for the patient to recover from this injury. The kind of surgery for reconstruction of the ligaments which are damaged isn’t that important. It is far more the experience and teamwork of the surgeons and physiotherapists involved in the treatment that makes the difference. [13] Total immobilization of the knee is not a good method of recovery for any type of knee sprain. This would lead to atrophy of the muscle groups of the upper leg and a weak feeling of the knee joint. [11]
Key Research[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Cedars Sinai. Health conditions. http://www.cedars-sinai.edu/Patients/Health-Conditions/Lateral-Collateral-Ligament-LCL-Tears.aspx (accessed 2 May 2011)
- ↑ Medscape reference. Drug, Conditions & Procedures.http://emedicine.medscape.com/article/307959-overview#showall (accessed 2 May 2011)
- ↑ 3.0 3.1 3.2 J. A. K. Davies, P. Gayle, A. Brochert. LCL injury- Lateral Collateral Ligament Injury. http://www.medicineonline.com/articles/l/2/lcl-injury/lateral-collateral-ligament-injury.html (accessed 5 May 2011)
- ↑ PhysioAdvisor. LCL Tear (Lateral Collateral Ligament)http://www.physioadvisor.com.au/10196250/lcl-tear-lateral-collateral-ligament-lcl-injur.htm (accessed 6 May 2011)
- ↑ 5.0 5.1 J. A. Recondo, E. Salvador, J.A. Villanúa, M.C. Barrera, C. Gervás, J.M. Alústiza. Lateral Stabilizing Structures of the Knee: Functional Anatomy and Injuries Assessed with MR Imaging. Radiographics 2000; 20 Spec No: S91-102. http://www.ncbi.nlm.nih.gov/pubmed/11046165 full text: http://radiographics.rsna.org/content/20/suppl_1/S91.full.pdf+html (accessed 2 May 2011)
- ↑ Medscape reference. Drugs, Conditions & Procedures. http://emedicine.medscape.com/article/89819-overview#showall (accessed 4May 2011)
- ↑ eOrif. Lateral Collateral Ligament Tear. http://www.eorif.com/KneeLeg/LCL.html (accessed 8 May 2011)
- ↑ Hai-ning Zhang, Jie Zhang, Cheng-yu Lv, Ping Leng, Ying-zhen Wang, Xiang-da Wang, and Chang-yao Wang Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee J Zhejiang Univ Sci B. 2009 September; 10(9): 689–695
- ↑ FRANK R. NOYES, MD, LONNIE PAULOS, MD, LISA A. MOOAR, BA, and BEN SIGNER, BA Knee Sprains and Acute ; Knee Hemarthrosis ,Misdiagnosis of Anterior Cruciate Ligament Tears, Physical Therapy December 1980 vol. 60 no. 12 1596-1601
- ↑ Jennifer Baima , Lisa Krivickas Evaluation and treatment of peroneal neuropathy Curr Rev Musculoskelet Med. 2008 June; 1(2): 147–153
- ↑ 11.0 11.1 Reider B Medial collateral ligament injuries in athletes. Sports Med 21(2): 147- 156, 1996
- ↑ Pekka Kannus, MD Nonoperative treatment of Grade II and III sprains of the lateral ligament compartment of the knee , Am J Sports Med January 1989 vol. 17 no. 1 83-88
- ↑ Michael T Hirschmann, Nadia Zimmermann, Thomas Rychen, Christian Candrian, Damir Hudetz, Lukas G Lorez, Felix Amsler, Werner Müller and Niklaus F Friederich Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair, BMC Musculoskelet Disord. 2010; 11: 102
