This professional footballer presented acutely after an injury to his left knee. He described sustaining a varus force to his knee in a tackle followed by immediate pain. On examination he had a small effusion. There was isolated laxity of his lateral collateral ligament in 30 degrees flexion and subtle laxity in full extension. There was no evidence of other ligamentous laxity.
This player’s x-ray imaging was normal. MRI images show an isolated injury to the lateral collateral ligament. There is high T2 signal and disruption of the normal fibrillary pattern at the fibular attachment of the lateral collateral ligament (consistent with a grade three/full thickness injury). There is a mild volume of bone oedema in the medial femoral condyle (consistent with the varus injury mechanism) and a partial thickness tear of the biceps femoris tendon. The remainder of the posterolateral corner structures are normal. The other ligaments in the knee are also radiologically normal.
This player was managed successfully with a period of rehabilitation followed by a progressive return to football. He was able to return to limited football training seven weeks after the injury and played part of a competitive match ten weeks after the injury. He was more comfortable with his knee taped.
Isolated injuries to the lateral collateral ligament are rare but should be suspected when there is a clear history of a varus stress. These injuries often occur in association with injury to other important structures in the knee including the anterior cruciate ligament and the posterolateral corner. These structures should therefore be carefully clinically evaluated. In most cases an MRI scan is useful to confirm the injury but also to exclude other associated injuries. In many cases this injury can be successfully managed with time and rehabilitation. In some situations surgery may be considered.
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