In patients who have a complete lateral, or fibular collateral ligament (LCL), tear and noticeable side-to-side instability with activities, a lateral collateral ligament surgery is recommended. The term fibular collateral ligament (FCL) is more anatomically correct, but is more commonly referred to as lateral collateral ligament (LCL).
LCL surgery is very effective in restoring side-to-side stability to the knee and preventing varus gapping. During a clinical exam and varus stress radiographs, we will be able to confirm whether or not there is a complete LCL tear. It is important to note that an MRI scan can be inaccurate – especially in cases of a chronic situation where the LCL heals improperly – that is why it is important to properly analyze the pathology.
Treatment for LCL Injury
The severity of the LCL injury will determine the treatment method. In less sever cases, a remedy of rest, ice, compression, and elevation (RICE) along with the use of anti-inflammatory medications (NSAIDs) and pain relievers can alleviate discomfort and help diminish swelling. Increasing strength and rang-of-motion can be achieved through physical therapy, and ultimately restore the knee back to a healthy state.
Typically, patients who have a complete LCL tear will require surgical treatment. This surgical procedure is typically done as an open procedure in conjunct with arthroscopy. Dr. LaPrade will replace the torn lateral collateral ligament with a tissue graft. The graft is passed through the bone tunnels and attached to the femur and fibula bone using screws.
We prefer an anatomic technique for surgical reconstruction. With this technique, we use either an autograft or allograft hamstring tendon to reconstruct the lateral collateral ligament between its native course. First, a tunnel is reamed at the femoral attachment site, slightly proximal and posterior to the lateral epicondyle. We then secure the graft at this location with an interference screw in the prepared 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 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 passed through this. The graft is placed under tension, the knee is flexed to 20 degrees and a valgus reduction force is applied. A screw is then used to attach the graft in the fibular head. Once one confirms on exam under anesthesia that the varus gapping is eliminated, the procedure can then be ended.
Rehabilitation for LCL surgery involves early range of motion of the knee, starting at a minimum of 0 to 90 degrees the first day, and then after 2 weeks progressing further. Isolated hamstring exercises should be avoided for the first 4 months post-operatively. Patients should not place weight on the injured leg for 6 weeks and then may progress off of crutches and start the use of a stationary bike starting at week 6. They should avoid side-to-side activities, or step-up activities, until varus stress X-rays are obtained at 5 months post-operatively verify that there is sufficient healing of the reconstruction graft to allow further activities. For athletes, we usually recommend the use of a secure brace to allow them to initiate these activities and request that they wear it through the first year after surgery to maximize graft healing.
- Fibular Collateral Ligament and Biceps Femoris Bursa
- Biomechanical Analysis of an Isolated Fibular Collateral Ligament Injury
- Varus Stress Radiographs
- Posterolateral Attachments of the Knee
- Assessment of Healing of Grade III Posterolateral Corner Injuries
- Prospective MRI Study of Incidence of PLC and Multi-Ligaments