1. Lateral Collateral Ligament (LCL) Tear

2. Development of LCL Tear A varus force to the medial aspect of the knee while bearing weight can put enough stress on the LCL to tear it

3. Symptoms of LCL Tear There are three grades with different symptoms and severity Grade 1 symptoms (stretched ligament) – Mild Tenderness on the inside of the knee – No swelling need be present – Pain on Varus stress test but no laxity Grade 2 symptoms (partial thickness tear of the ligament) – Significant pain in the medial aspect of the knee – Moderate swelling present – Varus stress test will indicate moderate instability Grade 3 symptoms (full thickness tear, or complete tear) – Varied amounts of pain – Significant joint laxity on varus stress test – Complaints of instability (“wobbly” or “unstable” complaints) LCL tears with or without concomitant Posterolateral corner injury can produce instability of the knee as well as gait abnormalities in clinical presentation

4. Grades of Ligament Tears

5. Symptoms of LCL Tear Locking or catching with movement of the knee Stiffness The peroneal nerve passes near the ligament and can be compromised upon injury – Involvement results in numbness or weakness in the foot

6. Differential Diagnosis Tests Varus stress test Palpation of the lateral aspect of the knee from lateral femoral condyle to the lateral tibial plateau External Rotation Recurvatum test Posterolateral Drawer test

7. External Rotation Recurvatum Test

8. Posterolateral Drawer Test

9. Recommendation Time from injury, location, severity, and concomitant injuries will indicate need for surgery or if conservative treatment will be sufficient Grade II injuries are treated initially with immobilization, R.I.C.E., and protected weight bearing – After swelling subsides then stretching, resistive exercise, and progressive weightbearing can be initiated Grade I can begin second phase of grade II rehabilitation right away Grade III tears require surgical intervention and referral to a doctor

10. Prognosis Isolated grade I and II LCL tears do not respond as well to conservative treatment as MCL tears do and usually do not require surgical intervention – Most people in this group have no long term disability related to their injury Grade III tears will require surgery for repair

11. References Bahk MS, Cosgarea AJ. Physical examination and imaging of the lateral collateral ligament and posterolateral corner of the knee. Sports Med Arthosc. March 2006;14(1): 12-9. Zhong YL, Wang Y, Wang HP, Rong K, Xie L. Stress changes of lateral collateral ligament at different knee flexion with or without displaced movements: A 3-dimensional finite element analysis. Chin J Traumatol. April 2011;14(2): 79- 83.