LCL Tear (Knee Injury, Pain, Swelling)
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LCL tear can be defined as overstretching of the ligaments present on the outside of the knee that causes them to tear, the lateral collateral ligament is a thin band of fibers that connects the femur (thighbone) with the fibula (a tiny bone that connects the knee with the ankle).LCL tear is a common injury among football and hockey players .The chief function of the lateral collateral ligament is to stabilize knee movements with the help of its complete curve of motion.
The LCL tear is caused due to an injury on the inside of the knee which can be the outcome of a direct blow to the knee, which causes the LCL ligaments present on the outside of the knee to overstretch causing them to tear. The LCL tear can take place in the middle or the two extreme ends of the ligament.
It is usually caused while playing games that involve fierce collisions between the players (e.g. hockey and football). Repeated stress to the LCL also causes LCL tear and injury to the surrounding ligaments as it causes the ligament to lose its elasticity.
The LCL is a very important ligament of the knee. It provides stability to the knee by preventing extreme side to side activities and twisting of the knee. However when the knee is forced into these extreme movements which are outside the withstanding capacity of the LCL, it tears causing a condition known as LCL tear.
Classifying a LCL tear
LCL tear can vary from partial tear of the ligament fibers leading to slight discomfort during movements of the knee region to complete rupture of all the LCL fibers leading to disability to move and considerable amount of pain. LCL tear can be classified into three separate grades depending on the amount of damage that the LCL has suffered and the amount of pain it is causing.
Grade 1 LCL tear
Grade 1 LCL tear involves tearing of a few LCL fibers (partial LCL tearing) leading to slight discomfort but no functional disability of the knee.
Grade 2 LCL tear
Grade 2 LCL tear involves tearing of a large number of LCL fibers causing slackness in the knee when it is moved. There is a lot of pain, tenderness and swelling in the knee area. Movement of the knee is difficult and accompanied with a lot of pain and discomfort.
Grade 3 LCL tear
This consists of complete rupture or tearing of the LCL leading to instability of the knee and considerable loss of function along with lot of tenderness, swelling and pain in the knee. Movement of the knee causes it to open around 0.5 inch. Grade 3 LCL tear is almost always accompanied with tearing of some surrounding structures like anterior cruciate ligaments or meniscus.
Extent of damage assessment
The extent of damage to the LCL is diagnosed on the basis of how the injury occurred and the amount of pain and discomfort associated with knee movements. Depending upon the extent of damage to the lateral collateral ligament , treatment is provided to heal the tear which can vary from wearing a light brace (in case of grade 1 injury) to surgery (in case of grade 3 injury).The treatment provided also depends on the athletic ambition of the patient.
The assessment of the damage is done by resolving factors that have contributed towards the development of LCL tear.
Examination and observation
The physiotherapist examines the injured knee joint and estimates the amount of deformity, bruising, tenderness, warmth and swelling in the knee area. In case of LCL tear, the examination of the torn ligament varies from slight tenderness (when there is partial LCL tear) to extreme pain (when there is complete LCL tear).
Range of movement
After examining the knee, the physiotherapist checks the range of movement of the knee. In this process, the therapist usually asks you to straighten and bend the knee a few times and then relax. Usually only grade 3 LCL tear affects the knee’s range of movement. In case of grade 2 LCL tear, the function of the knee is not much affected.
Varus muscle test
Next, the therapist asks for bending and straightening of the knee even if there is resistance. A resisted knee muscle test causes the contraction of the muscles. Contraction of the muscles or pain suggests the presence of muscular injury.
Muscle stress test
In this test, the therapist holds the limb and bends the knee at an angle of 30 degree. After this, inward pressure is applied on the lower leg to stabilize the thigh. This procedure causes stretching of the lateral collateral ligament. If the stretching is accompanied by pain, then LCL tear is confirmed.
The extent of the LCL tear is determined on the basis of the extent of mobility or stability present in the knee.
Symptoms of the LCL tear
Tenderness and swelling on the outside of the knee
Weakness or numbness in foot (this happens if the peroneal nerve is stretched in the process of the LCL tear).
Looseness of knee
Instability of knee
Catching or locking of the knee joint when it is moved.
LCL tear is diagnosed by applying pressure outside the knee to check if there is tenderness or pain inside the knee.
As LCL tear is almost always accompanied by swelling and pain which makes the accurate diagnosis of the extent of injury a little difficult. In case of swelling, it is advised to wear an ice pack or a light brace till the pain and swelling subsides a little. This helps in the correct diagnosis of the extent of LCL tear. Other tests that are done to diagnose LCL tear include:
MRI (Magnetic Resonance Imaging) – this test yields accurate results in 90% of LCL tear cases and is commonly employed if the initial physical examination of the knee does not produce reasonable diagnosis.
X-ray test – this test is done to assess the alignment of bones around the knee.
Treatment of the LCL tear depends on the extent of damage the LCL and its surrounding ligaments have suffered. An LCL tear is usually accompanied by tear and injury in its surrounding ligaments and other structures also.
In case of grade 1 injury, the treatment procedure involves lessening the pain and swelling with the help of pain relievers like ibuprofen and physiotherapy. You might be required to wear a light brace to prevent side to side movement of the knee. Rest is mandatory and usually after 3-4 days of resting and physical therapy, you are on the pathway of recovery and rehabilitation.
Once the pain has subsided, the recovery exercises to restore normal range of movement and strength is carried out. If the exercise process still causes pain, you should exercise slowly in order to prevent any more pain. The full recovery process after the treatment can take around eight weeks for a grade 1 LCL tear.
If the LCL tear has taken place in the region where the LCL attaches to the tibia (shinbone) or femur (thighbone), then the treatment procedure involves surgery. The LCL tear in this case is repaired by reattaching the completely torn ligament to the tibia or femur with the help of bone staple or large stitches.
If the LCL tear has taken place in the middle of the ligament, then it is repaired by sewing the torn ligament ends together.
If the LCL tear has damaged the ligament beyond repair, then it has to be reconstructed using a tendon taken from your hamstring or quadriceps (thigh muscles). LCL reconstruction is done using an open knee method. The tendon graft that has been taken out is arthroscopically attached to the fibula and thighbone with the help of posts or screws or stitches.
RICE is an acronym for resting, icing, compression and elevation. In the beginning when the LCL tear has just taken place, this treatment is the best for the first three days after the injury. It reduces swelling and pain and fastens the healing process.
LCT tear can be healed with physiotherapy in most of the cases. The effectiveness of physiotherapy depends upon the patient’s obedience. This treatment procedure requires the patient to rest a lot and restrain from any activity that puts pressure on the knee.
After the treatment of the LCL tear is over, you are required to enter the rehabilitation process which includes:
Resting for a certain period
Light bracing in the knee area
Refraining from any activity that applies pressure on the knee
The rehabilitation process is followed by physiotherapy.
This is also a part of the LCL tear treatment process. It helps in speeding up the healing process and preventing its future recurrence. Physiotherapy includes:
a gradual return to activity program
soft tissue massage
motion modification advice
heat or ice treatment
exercises to recover strength, flexibility and balance
Apart from physical therapy, there are many products that help in accelerating the healing process. These protection products include:
Spiky massage balls
Hot packs or ice packs
Patients who have suffered LCT tear are usually recommended the following exercises in order to regain their normal knee functions .These exercises are to be performed three times every day.
Knee bending and straightening
This exercise involves bending and straightening of the knee 20 times without applying too much stress on it.
Static thigh muscle contraction
The LCL tear affected knee is pushed down into a towel, kept there for 5 minutes and then this is repeated ten times without increasing the LCL tear symptoms.
Other exercises for LCL tear recovery include knee flexibility exercises and knee strengthening exercises.