Collateral ligament (CL) injury - aftercare

The collateral ligaments help keep your knee stable. They help keep your leg bones in place and keep your knee from moving too far sideways.

A collateral ligament injury can occur if you get hit very hard on the inside or outside of your knee, or when you have a twisting injury.

Skiers and people who play basketball, football, or soccer are more likely to have this type of injury.

With a collateral ligament injury, you may notice:

• A loud pop when the injury occurs
• Your knee is unstable and can shift side to side as if it "gives way"
• Locking or catching of the knee with movement
• Knee swelling
• Knee pain along the inside or outside of your knee

After examining your knee, the doctor may order these imaging tests:

• An MRI of the knee. An MRI machine takes special pictures of the tissues inside your knee. The pictures will show whether these tissues have been stretched or torn.
• X-rays to check for damage to the bones in your knee.

If you have a collateral ligament injury, you may need:

• Crutches to walk until the swelling and pain get better
• A brace to support and stabilize your knee
• Physical therapy to help improve joint motion and leg strength

Most people do not need surgery for an MCL injury. However, you may need surgery if your LCL is injured or if your injuries are severe and involve other ligaments in your knee.

Follow R.I.C.E. to help reduce pain and swelling:

• Rest your leg. Avoid putting weight on it.
• Ice your knee for 20 minutes at a time, 3 to 4 times a day.
• Compress the area by wrapping it with an elastic bandage or compression wrap.
• Elevate your leg by raising it above the level of your heart.

You can use ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn) to reduce pain and swelling. Acetaminophen (Tylenol) helps with pain, but not swelling. You can buy these pain medicines at the store.

• Talk with your doctor before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• DO NOT take more than the amount recommended on the bottle or by your doctor.

You should not put all of your weight on your leg if it hurts, or if your doctor tells you not to. Rest and self-care may be enough to allow the tear to heal. You should use crutches to protect the injured ligament.

You may need to work with a physical therapist (PT) to regain knee and leg strength. The PT will teach you exercises to strengthen the muscles, ligaments, and tendons around your knee.

As your knee heals, you can return to normal activities and maybe play sports again.

Call your doctor if:

• You have increased swelling or pain
• Self-care does not seem to help
• You lose feeling in your foot
• Your foot or leg feels cold or changes color

If you have surgery, call the doctor if you have:

• A fever of 100°F (38°C) or higher
• Drainage from the incisions
• Bleeding that won't stop

Lento P, Marshall B, Akuthota V. Collateral ligament sprain. In: Frontera, WR, Silver JK, Rizzo TD, Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

Miller RH, Azar FM. Knee injuries. In: Azar FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 45.

Niska JA, Petrigliano FA, McAllister DR. Anterior cruciate ligament injuries (including revision). In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 98.

Wilson BF, Johnson DL. Medial collateral ligament and posterior medial corner injuries. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 100.