Lateral collateral ligament injury to runners

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Lateral collateral ligament (LCL) injury is much less common than medial collateral ligament (MCL) injury.

Injury to the lateral collateral ligament most often occurs when an athlete is being hit at the anteromedial (inside front) part of the tibia (lower leg bone) such as during a tackle in football. It is very uncommon in a non-contact sport like running.

The LCL is a ligament that lies beneath the tendon of the biceps femoris (thigh) muscle. The LCL runs from the lateral epicondyle, a bony prominence at the lower end of the femur (upper leg bone) and connects to the fibular head (upper outside part of the lower leg bones).

The LCL is tight when the knee is extended and loose when it is flexed greater than 30°.

Most acute injury mechanisms are secondary to direct contact to the anterior and medial aspect of the tibia.

Other parts of the knee in this area can be injured and cause diagnostic confusion. These include the iliotibial band, a tendon along the outside of the knee, long and short head of the biceps femoris muscle, fibular collateral ligament, and the joint capsule.

The peroneal nerve also can be injured because it lies next to the biceps tendon.

Tendonitis of the biceps femoris and ITBS typically are due to overuse.

oITBS is caused by an inflammatory reaction at the distal insertion of the band as it rubs over the lateral femoral epicondyle.

oITBS is the second most common cause of knee problems in runners. There is sharp lateral knee pain usually during knee flexion. This type of injury should be suspected in a runner who has suddenly increased his/her distance, speed, or hill running.

oITBS also may occur in cyclists. The injury is worsened by pedaling when there is internal tibial rotation during knee flexion at approximately 30°.

MRI is the procedure of choice for meniscal and ligament evaluation.

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