Lateral ligament sprain

Findings

a)      Acute – pain or laxity to varus stress, except that a Pellegrini – Stieda complication is not associated with the lateral side

b)      Chronic – passive, varus strain, evokes pain over the lateral ligament and, if the capsule is not involved, the knee may have pain-free, full passive flexion and extension. It is locally tender to palpation over the joint line, femoral condyle, or its insertion at Gerdy’s tubercle on the tibia

Cause

a)      Acute – forced varus injury at the knee, which may have a rotational element, and accompanying capsular or meniscal damage

b)      Chronic – congenital varus knee(low legged), often with equino varus feet. Camber running will produce a varus load on the lower leg.

Treatment

a)      Initially is to reduce the oedema and inflammation – RICE

b)      Support weight – bearing with a hinged brace, for preference, and non-weight-bearing with crutches

c)      Electrotherapeutic modalities to settle inflammation and encourage healing, such as ultrasound, laser and interferential

d)     Organize healing tissue with massage and by maintaining the range of movement with non-weight-bearing extension and flexion, both active and passive

e)      Cross- train, non-impact, such as cycling, rowing or swimming, but not breaststroke. Build to the knee ladders

f)       Surgical repair of a grade 3 total rupture and major posterolateral corner lesions.

Sports

a)      Acute – mainly an injury from contact sports, though, occasionally, sudden checking and twisting with the foot locked to the ground, as on artificial surfaces, may cause the strain

b)      Chronic – usually there has been no trauma. Running and “straight line” work, which repair the same strains over the ligament, cause the problem. Thus “change of direction” sports, which vary these stresses, are less of a problem. However, camber running will produce a varus load on the lower leg and stress the lateral ligament

Lateral ligament injuries are not as common as the medial collateral ligament injuries. If major posterolateral corner damage occurs then the knee is inherently unstable and requires surgery.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English