Sprain, lateral collateral ligament

• LCL sprain

• 844.0 Sprain of lateral collateral ligament of knee

• S83.429A Sprain of lateral collateral ligament of unspecified knee, initial encounter

• 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Bony or Soft Tissue Surgery1

Description

• Tear of the lateral collateral ligament of the knee
• Graded based on extent of damage
  • Grade I: localized tenderness with no instability
  • Grade II: localized tenderness, moderate fiber disruption, slight to moderate abnormal motion
  • Grade III: complete fiber disruption, noted instability

Essentials of Diagnosis

• Injury is generally traumatic, can occur at any age; trauma usually a high-impact force applied to the medial knee
• Clinical diagnosis generally made through history of injury and knee varus stability testing
• Diagnosis may be confirmed with MRI

General Considerations

• Lateral collateral ligament is most taut in extended knee position

Demographics

• Injury to lateral collateral ligament less common than to medial collateral
• Most common in young athletic population

Signs and Symptoms

• Lateral knee pain
• Pain with palpation over lateral knee
• Pain with varus force to knee
• Pain with extension
• Feeling of instability or “giving way” in the knee

Functional Implications

• Pain with swinging legs in/out of car or bed
• Decreased stability while walking on uneven surfaces
• Decreased stability with change of direction

Possible Contributing Causes

• Usually related to traumatic varus stress applied to the knee
  • Sports injury
  • Motor vehicle accident
• May be related to severe, degenerative osteoarthrosis

Differential Diagnosis

• Joint-line pain related to knee osteoarthrosis
• Iliotibial band syndrome
• Biceps femoris tendinopathy or strain
• Arcuate-popliteal complex
• Anterior cruciate ligament sprain or tear
• Posterior cruciate ligament sprain or tear
• Proximal tibiofibular joint pathology
• Referred pain to hip, low back, sacroiliac joint

Laboratory Tests

• Knee varus stress test in 30˚ knee flexion
• Grading of laxity2
  • 1+ = 3-5 mm laxity
  • 2+ = 6-10 mm laxity
  • 3+ = greater than 10 mm laxity

Imaging

• MRI
• Valgus stress radiograph3
  • Isolated injury of LCL
    • Increased lateral joint gap of 2.7 mm
  • Grade-III posterolateral corner injury
    • Increased lateral joint gap of 4.0 mm

• Pain, tenderness, swelling in lateral knee from tissue disruption and inflammatory process
• Possible laxity with varus force to knee, depending on extent of tissue disruption
• Reports of “giving way” or instability with walking due to decreased lateral stability of the knee

• To physician for pain management
• To hospital for MRI if questionable diagnosis or if meniscus injury or tibial plateau fracture suspected
• To physician, orthotist or physical therapist ...