The lateral collateral ligament is the ligament on the outside of the knee that links the thigh bone and the shin bone. Damage to a ligament is referred to as a sprain, and depending on the severity of the injury it is classified as first, second or third degree. The injury is less common than damage to the medial ligament, but in collision sports such football, the lateral ligament can be damaged when an opponent applies a force (usually a kick) to the outside aspect of the leg just below the knee.

The example outlined is for a lateral knee ligament, but the basic recognition and initial treatment is applicable for most ligament injuries

Knee Ligament Injury - First degree sprain

Where only a few ligament fibres are damaged. As an example, with a first degree sprain of the lateral knee ligament there will typically be pain when the the site of the damage is touched. Stressing the ligament (when the knee is slightly bent and the shin is moved inwards in relation to the thigh) is painful; this action is reproduced when standing up from sitting in a chair.

Treatment

The RICE protocol should be followed - Rest, Ice, Compression and Elevation (never apply ice directly to the skin). The knee should be rested in an elevated position and a compression bandage should be used to help prevent excessive swelling. Ice packs applied for 20 minutes every 2 hours can aid pain relief and help to prevent more tissue damage by cooling.

In the case of a first degree sprain, sporting activities should not be undertaken for about 3 weeks

Knee ligament injury - Second degree sprain

There is more extensive damage to the ligament with associated swelling. In the case of a second degree sprain of the lateral knee ligament , the pain is more severe when the injury site is touched and when the ligament is stressed. Because the ligament is outside the knee joint, there may not be marked swelling of the knee.

Treatment

The RICE protocol should be followed - Rest, Ice, Compression and Elevation (never apply ice directly to the skin). The knee should be rested in an elevated position and a compression bandage should be used to help prevent excessive swelling. Ice packs applied for 20 minutes every 2 hours can aid pain relief and help to prevent more tissue damage by cooling.

For second degree sprains, the rehabilitation period will be between 6 and 8 weeks. Rehabilitation under the supervision of a chartered physiotherapist is desirable to prevent a recurrence of the injury, which can be common if a return to sport is attempted too early.

Knee ligament injury -Third degree sprain

This is a complete rupture of the ligament with swelling and a possible joint dislocation. In a sports person this will usually require surgery. In the case of a third degree sprain, where the ligament is ruptured, the pain is excruciating and the knee joint becomes unstable.

Treatment

The RICE protocol should be followed - Rest, Ice, Compression and Elevation (never apply ice directly to the skin). The knee should be rested in an elevated position and a compression bandage should be used to help prevent excessive swelling. Ice packs applied for 20 minutes every 2 hours can aid pain relief and help to prevent more tissue damage by cooling.

In the case of a third degree sprain, where the ligament is completely ruptured, the treatment of choice is surgery to repair the structure. The type of reconstruction used will depend on the exact site of the damage and the preference of the surgeon.

Prevention

In the case of a player who has had a previous lateral ligament injury there will always be a weakness, but there are measures that can be taken to help prevent a recurrence. Following a rehabilitation programme under the supervision of a chartered physiotherapist will help. This should include a lot of proprioceptive exercises, these improve the stimuli within the body relating to position and movement, since proprioceptive ability will be affected by the damage to the ligament.

Proprioceptive exercises

Apart from mobilising and strengthening exercises, the rehabilitation for a knee ligament injury can be greatly enhanced by practicing what are called proprioceptive exercises. These enhance neuromuscular control around a joint and are very important in the rehabilitation progress. These exercises should be started as soon as pain allows.

• The player balances on the affected leg while partial weight-bearing. This should be done for 1 minute, followed by rest periods to avoid muscular fatigue.
• Proprioceptive exercises can be done while partial weight-bearing first, then progressed to full weight-bearing.
• The patient balances on the affected leg for 1 minute, followed by rest periods to avoid muscular fatigue.