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Lateral collateral ligament one of the 4 main ligaments of knee. Patients with LCL injury have side to side instability and the knee opens up on varus stress. These patients with clinical instability need surgery. Clinical exam and varus stress radiographs are mainstay in diagnosing the LCL tear as MRI can give inaccurate information due to improper healing.
Treatment for LCL Injury
It depends on the severity of tear, in less severe injury RICE (Rest, Ice, Compression, and Elevation) along with nsaids and physical therapy are the mainstay of treatment.
In complete tears we do surgical reconstruction.
We do arthroscopic assisted LCL reconstruction. We do fibula tunnel technique for surgical reconstruction. With this technique, we use an autograft hamstring tendon to reconstruct the lateral collateral ligament. First, a tunnel is reamed through the fibular head, starting laterally at the exact attachment site of the LCL on the fibular head, and exits on the medial aspect of the fibular styloid just distal to the popliteofibular ligament the graft is then looped through the tunnel. The graft is then passed under the superficial layer of the iliotibial band and the lateral aponeurosis of the long head of the biceps femoris. Next, a tunnel is reamed at the femoral attachment site, slightly proximal and posterior to the lateral epicondyle. The graft is then passed through this. The graft is placed under tension, the knee is flexed to 20 degrees and a valgus reduction force is applied. We then secure the graft at this location with an interference screw in the prepared tunnel. Confirm on exam under anesthesia that the varus gapping is eliminated.
Rehab includes rom exercises to start as early as within 24 hrs. The patient is kept on weight bearing for 6 weeks f/b gradual weight bearing and stationary cycling Return to sport take around 6-9 months