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LCL Tear S83.429A 844.0

 

synonyms: fibular collateral ligament tear, lateral collateral ligament tear, LCL tear

 

LCL ICD-10

 

A- initial encounter

D- subsequent encounter

S- sequela

LCL ICD-9

  • 844.0 Sprain and strains of knee and leg; lateral collateral ligament of knee.
  • 717.81 Old disruption of knee ligament; lateral collateral ligament

LCL Etiology / Epidemiology / Natural History

  • Isolated injury is uncommon.

LCL Anatomy

  • Origin: Lateral femoral epicondyle posterior and superior to the insertion of the poplitieus.
  • Insertion: Fibular head
  • Function: Primary restraint to varus stress of the knee. Resist tibial external rotation.
  • Tight in extension, lax in flexion.

LCL Clinical Evaluation

  • Lateral knee tenderness.
  • Varus laxity with the knee in 30° of flexion as compared to normal side indicates isolated LCL tear. Laxity in full extension is indicative of a more severe injury involving multiple ligaments and potentially both cruciates.
  • Isolated injury is uncommon.

LCL Xray / Diagnositc Tests

  • A/P, lateral knee xrays: generally normal.
  • MRI: Grade 1 = edema (increased T2 signal) superficial to intact ligament. Grade 2 = edema within the substance of the ligament with some intact fibers. Grade 3 = complete ligament disruption (high signal traversing ligament on T2 images. (Schweitzer ME, Radiology, 1995;22:411)

LCL Classification / Treatment

  • Acute Isolated LCL injury:
    Grade I injury (0 to 5 mm of medial opening). Treatment: Hinged knee brace with early motion and functional rehabilitation. Typically brace opened from 15° to 60° for first 4weeks. Then open 0°-120°for 4 weeks for a total of 8 weeks of bracing.
    Grade II injury (6 to 10 mm of medial opening). Treatment: Hinged knee brace with early motion and functional rehabilitation. Typically brace opened from 15° to 60° for first 4weeks. Then open 0°-120°for 4 weeks for a total of 8 weeks of bracing.
    Grade III injury (11 to 15 mm of medial opening). Treatment: LCL repair, ensure other ligments are not injured as isolated Grade III injuries are uncommon.
  • Chronic LCL injury which has failed non-operative treatment.
    Treatment: LCL repair.
  • Acute Multiple ligament knee injury / Knee Dislocation
    Treatment: LCL repair. + cruciate ligmanet repair + posterolateral reconstruction.
  • Chronic PLC instability with varus knee alignment: Treatment = valgus-producing HTO. Soft tissue reconstructions will eventually stretch out and fail. (Naudie DD, AJSM 2004;32:60).

LCL Associated Injuries / Differential Diagnosis

  • Posterolateral corner
  • PCL Tear
  • Meniscus tear
  • MCL tear
  • Chondral injury
  • ACL tear
  • Patellar Dislocation
  • Popliteus avulsion
  • Knee Dislocation

LCL Complications

  • Instability
  • Stiffness:
  • Painful hardware:
  • Infection:
  • Arthrofibrosis: rare
  • NVI (peroeal nerve): rare
  • Complex Regional Pain Syndrome: rare
  • Hemarthrosis

LCL Follow-up Care

LCL Review References

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