LCL | Lateral Collateral Ligament Injury of the Knee

Danielle R. Steilen-Matias, MMS, PA-C

If you are reading this article it is very likely that you have now moved beyond the simple treatments of knee pain that you did on your own including, REST (Rest, Ice, Compression, Elevation), buying different types of knee braces specifically designed for a suspected lateral collateral ligament (LCL) injury. Taking a lot of anti-inflammatories. You may now have also moved on to numerous doctor appointments, physical therapy, and sometimes stronger medications.

The lateral collateral ligament (LCL) is one of four critical ligaments involved in stabilizing the knee joint. Stabilizing the knee on the outside, or lateral side, of the joint, it extends from the top-outside surface of the fibula, the bone on the outside of the lower leg, to the bottom-outside surface of the femur, the thigh bone. A lateral collateral ligament injury involves a stretch, partial tear or complete tear of this particular knee ligament. In some instances the injury is significant enough to cause an avulsion fracture of fibular head (out top area of the shin bone).

Before reading on, do you have a question?

Look at new research examining the crucial role of the knee’s lateral collateral ligament in stabilizing or destabilizing an ACL deficient knee.

While we look at the LCL’s involvement in knee stabilization, no ligament or stabilizing structure in the knee should ever be considered an “island unto itself.” Each stabilizer interacts with other stabilizes to provide the highly active knee with support.

The effect of the LCL on Knee Instability

Doctors at Tokyo Medical and Dental University compare the relationship between knee ligaments and knee stability.

Lateral knee instability was greater in ACL-deficient knees than in uninjured knees.
Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI
Also troubling was the MRI had poor results in showing lateral knee instability.
Lateral knee instability was much more significant to knee destabilization than medial collateral ligament (MCL) injury in ACL-related instability.1

Our interpretation: ACL damage in knee, undetected lateral knee instability, whole knee not treated, chronic instability.

The greater importance of the lateral stabilizers of the knee are confirmed by Mayo Clinic surgeons who performed reconstructive surgery on completely ruptured LCLs.

In patients undergoing multiligament knee reconstruction, the Mayo physicians suggest that those who undergo medial repair for knee dislocations are not as likely to achieve positive results as those who undergo reconstruction or lateral reconstruction/repair.2

Two things, the LCL stabilizers need to be fixed, reconstruction for MCL is not as successful a procedure.

The regenerative treatment for a lateral collateral ligament injury using Prolotherapy

When the LCL is overstretched or partially torn, a preferred treatment is one that will regenerate the ligament and stimulate healing of the original ligament rather than replacing it through surgery. Prolotherapy is the treatment option that strengthens and repairs ligaments. Motion and exercise would also be encouraged along with Prolotherapy for proper healing of the knee joint.

In the Journal of Prolotherapy, Caring Medical researchers wrote:

One of the most important advances in the treatment of ligament injuries has come from the understanding that controlled early resumption of activity can stimulate repair and restoration of function, and that treatment of ligament injuries with prolonged rest may delay recovery and adversely affect the tissue to repair.
Likewise, although steroid injections and nonsteroidal anti-inflammatory medications have been shown to be effective in decreasing inflammation and pain of ligament injuries for up to six to eight weeks, the histological, biochemical, and biomechanical properties of ligament healing are inhibited. 3

Once again, since injury of the LCL often involves other ligaments, Prolotherapy for an injured LCL would be comprehensive.

Comprehensive Prolotherapy to the knee involves multiple injections of a dextrose-based solution to all of the affected ligaments and other injured structures of the knee.
These injections stimulate the body’s natural immune response, an inflammatory response, which boosts the blood supply in the injured area.
This triggers a cascade of healing events, including reparative cells and collagen cells which are sent to the needed areas of the knee.

It is possible that a totally torn or ruptured ligament may require surgery, however, since Prolotherapy has been shown to regenerate tissue, it should be tried as a first line treatment before considering surgery. Prolotherapy will also heal the other injured ligaments involved in the forceful knee injury. If necessary, the experienced Prolotherapist will know when to use a more aggressive approach such as Platelet Rich Plasma Prolotherapy for knee repair or Stem Cell Injection Prolotherapy for knee repair to help heal the injured structures of the knee.

Please see our article on Knee Instability for research on Prolotherapy.

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1 Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci. 2016 Nov 19. pii: S0949-2658(16)30217-2. doi: 10.1016/j.jos.2016.10.009. [Pubmed]
2. King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees. Arthroscopy. 2016 Sep;32(9):1814-9. [Pubmed]
3. Hauser R. Ligament Injury and Healing: An Overview of Current Clinical Concepts Journal of Prolotherapy. 2011;3(4):836-846. [JOP]