Management of Lateral Collateral Ligament (LCL) Injuries
The management of LCL injuries should be based on injury grade, with early surgical reconstruction recommended for complete tears as the risk of additional soft tissue damage increases within 3 months of injury. 1
Classification and Assessment
LCL injuries are graded as:
- Grade I: Stretching with minimal fiber disruption
- Grade II: Partial tear with some instability
- Grade III: Complete tear with significant instability
Key physical examination findings:
- Varus stress test at 30° knee flexion (primary test for LCL integrity)
- Assessment for posterolateral rotatory instability
- Evaluation for concomitant injuries to other knee structures
Treatment Algorithm
Conservative Management (Grade I and II Injuries)
Indicated for:
- Grade I (mild) injuries
- Grade II (moderate) injuries without significant instability
- Isolated LCL injuries without other ligamentous involvement
Protocol includes:
- Initial RICE (Rest, Ice, Compression, Elevation)
- Hinged knee brace for protection
- Progressive weight-bearing as tolerated
- Early range of motion exercises
- Strengthening exercises focusing on lateral stability
Surgical Management (Grade III or Combined Injuries)
Indications:
- Complete (Grade III) LCL tears
- LCL injuries with concomitant ligament damage (especially ACL/PCL)
- Failed conservative management with persistent instability
Timing:
- Early reconstruction is preferred as the risk of additional soft tissue damage increases within 3 months of injury 1
- Acute intervention (within 2-3 weeks) offers better outcomes than delayed reconstruction
Surgical options:
- Primary repair: For acute avulsion injuries with good tissue quality
- Reconstruction: For mid-substance tears or chronic injuries
- Anatomic reconstruction using autograft (preferred) or allograft
- Percutaneous technique may be considered in select cases 2
Special Considerations
Combined Ligament Injuries
- LCL injuries rarely occur in isolation and are often associated with injuries to other structures 2
- When LCL injuries occur with ACL tears, both ligaments should be addressed surgically
- In cases of combined ACL and lateral-side injuries, a comprehensive surgical approach is necessary to restore knee stability 3
Rehabilitation Protocol
- Post-surgical rehabilitation:
- Weeks 0-2: Immobilization in extension, partial weight-bearing
- Weeks 2-6: Progressive range of motion exercises in brace
- Weeks 6-12: Full weight-bearing, strengthening exercises
- Months 3-6: Sport-specific training
- Return to sports: Typically at 6-9 months based on functional testing
Follow-up and Monitoring
Regular follow-up is recommended to assess:
- Clinical and functional status
- Ligament stability
- Return of strength and proprioception
- Progression through rehabilitation milestones
Functional testing before return to sports:
- Hop tests
- Strength testing (comparing to uninjured side)
- Sport-specific movement assessments
By following this structured approach to LCL injury management, optimal outcomes can be achieved with restoration of knee stability and function.