Lateral Collateral Ligament of the Knee

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Search Strategy[edit | edit source]

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Definition/Description[edit | edit source]

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Clinically Relevant Anatomy[edit | edit source]

The lateral collateral ligament (LCL) is one of four critical ligaments involved in stabilizing the knee joint. The medial collateral ligament, the anterior cruciate ligament and the posterior cruciate ligament are the other stabilizers of the knee.

The lateral collateral ligament or fibular collateral ligament has its origin on the lateral epicondyle of the femur and runs to the fibular head. [1][2]

When the knee is extended the LCL is stretched and it is loose when the knee is flexed (more than 30°).[3] The fibular collateral ligament is primary restraint to varus rotation from 0-30° of knee flexion, varus rotation is when the distal part of the leg below the knee is deviated inward, resulting in a bowlegged appearance. Secondarily it also acts to resist internal rotation forces of the tibia. The LCL has no direct contact with the joint capsule or lateral meniscus, it’s separated from it by a small fat pad.

There are different grades for the LCL, they will be classified as follows:[3][3]

Grade 1: Some tenderness and minor pain at the lateral side of the knee, pain when the distal part of the leg below the knee is deviated inward (varus stress). This means there have been small tears in the ligament.

Grade 2: Noticeable looseness in the knee, a joint space opening of about 5-10mm is present when moved by hand. There have been larger tears in the ligament = Joint instability of the knee. Major pain and tenderness at the inner side of the knee and some swelling is a consequence.[4]

Grade 3: Noticeable looseness in the knee, a joint space opening of >10mm is present when moved by hand. This means the ligament is completely torn. Considerable pain and tenderness at the inner side of the knee and some swelling are also noted. There may also be a tear of the anterior cruciate ligament.[4]

 For grade 1 and 2 the suggested treatment includes rest, ice, compression, elevation (RICE)


 Grade 3 is best treated with surgical intervention


Symptoms of a tear in the lateral collateral ligament are:[5]
o Knee swelling
o Locking or catching of the knee with movement
o Pain or tenderness along the outside of the knee
o Knee gives way, or feels like it is going to give way, when it is active or stressed in a certain way

Purpose
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The lateral collateral ligament stress test (varus stress test) is used to estimate the lateral collateral ligament, to see whether it is this ligament that causes the instability in the knee.

The purpose of this test is to determine if there is looseness in the ligament and if an MRI or x-ray would be necessary. Serious tears or ruptures of the lateral collateral ligament may require surgery.

Technique
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Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

The lateral collateral ligament, located on the lateral side of the knee has its origin on the lateral epicondyle of the femur and his insertion on the fibular head. It is the primary varus stabilizer of the knee. This ligament is restraint to varus rotation from 0-30° of knee flexion and it also acts to resist internal rotation forces of the tibia.

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References[edit | edit source]

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  1. ↑ M.shünke, E.S (2005). Anatomische atlas prometheus, algemene anatomie en bewegingsapparaat. Bohn Stafleu van Loghum
  2. ↑ William C.Whiting, R.F. (2008). Biomechanics of musculoskeletal injury. Second Edition
  3. ↑ 3.0 3.1 3.2 eMedicine on Medscape, Sherwin SW Ho, MD. Lateral Collateral Knee Ligament Injury, Updated: Feb 28, 2010 http://emedicine.medscape.com/article/89819-overview
  4. ↑ 4.0 4.1 Schoen, D.C.(2000). Adult orthopaedic nursing. Lippincott
  5. ↑ Medlineplus, Linda J. Vorvick, MD. Lateral collateral ligament (LCL) injury, Update Date: 6/13/2010 http://www.nlm.nih.gov/medlineplus/ency/article/001079.htm
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