Abstract
Objective:
Lateral collateral ligament (LCL) injuries can occur in isolation or as part of more extensive posterolateral corner (PLC) injury. Injuries can range from pure varus laxity, due to isolated LCL lesions, to pure posterolateral rotatory laxity from isolated popliteus complex (including popliteo-fibular ligament) lesions, but most injuries occur in combination. Although excess laxity due to PLC injury is usually considered an absolute indication for repair or reconstruction, non-operative management of isolated LCL injuries is also possible.
The purpose of the present study is primarily to evaluate the outcome of non-operative treatment in a consecutive series of isolated LCL injuries in elite athletes as reflected by successful return to play, performance level, and rates of continued play at two- and five-years post injury. Furthermore, we hypothesised that the clinical and radiological grading of LCL injuries do not correlate.
Methods:
A consecutive series of elite athletes with posterolateral corner (PLC) injuries of the knee treated by two sports knee surgeons between January 2015 and June 2021 was identified. Only those with isolated LCL injuries were included. Data pertaining to clinical examination findings, radiological findings, treatment, return to play times, performance levels, and subsequent career longevity were collected.
Results:
Fifty-five professional athletes (44 soccer players), with a mean age of 24.3 years +/- 26 4.5 years, with MRI-confirmed isolated LCL injuries were included in final analysis. Clinical examination findings were notable for grade 0 laxity in 7/55 (12.7%) athletes, grade 1 in 42/55 (76.4%), grade 2 in 6/55 (10.9%), and grade 3 in 1/55 (1.8%). All patients were treated with restricted activities and rehabilitation. MRI grading and clinical grading showed low correlation (r =0.37, p = 0.01). Return to play (RTP) was 100% at a mean of 96.8 (±75.6) days. At 2 years, 51 athletes (92.7%) were still playing elite sport. At 5 years participation in elite sport reduced to 84.4% (27 of 32 players). All athletes returned to their pre-injury level of play. No athletes stopped elite sport secondary to their LCL injury.
Discussion:
The current data suggests that non-operative management of isolated LCL injuries, including high grade 2-3 MRI grading, is associated with high return to pre-injury level of sport (100%), reasonable recovery times (median 76 days), and no significant residual varus instability. There is low correlation of MRI grade of isolated LCL injury with clinical examination findings. The authors recommend these lesions be treated without surgery in nearly all cases.