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Lateral ligament tears of the knee joint: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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ICD-10 code
S83.4 Sprain and rupture of (internal/external) collateral ligament of knee joint.
What causes lateral knee ligament tears?
Ruptures of the lateral ligaments of the knee joint occur with an indirect mechanism of injury - excessive deviation of the tibia inward or outward, while the lateral ligament opposite the side of the deviation is torn.
Symptoms of lateral knee ligament tears
Patients are concerned about pain and instability in the knee joint, and the pain is local - at the site of the rupture.
Diagnosis of ruptures of the lateral ligaments of the knee joint
Anamnesis
History of characteristic trauma.
Inspection and physical examination
The joint is swollen, its contours are smoothed. On the 2nd-3rd day after the injury, a bruise appears, sometimes extensive, descending to the shin. The presence of free fluid (hemarthrosis) is determined: a positive symptom of oscillation and balloting of the patella. Palpation reveals local pain in the projection of the damaged ligament.
In case of rupture of the lateral ligament, excessive deviation of the shin to the side opposite to the damaged ligament is noted. For example, if there is a suspicion of rupture of the internal lateral ligament, the doctor fixes the outer surface of the patient's knee joint with one hand, and with the other deflects the shin outward. The ability to deflect the shin outward significantly more than on a healthy leg indicates a rupture of the internal lateral ligament. The patient's leg should be straightened at the knee joint during the examination. In case of acute injury, these studies are performed after procaine is injected into the cavity of the knee joint and its anesthesia.
After the acute period subsides, patients continue to have instability of the knee joint ("dislocation"), which forces victims to strengthen the joint by bandaging or wearing a special knee brace. Gradually, atrophy of the limb muscles develops, and signs of deforming gonarthrosis appear.
Laboratory and instrumental studies
If deforming gonarthrosis has begun to develop, the clinical diagnosis can be confirmed by X-ray examination using the device offered in the clinic. The X-ray clearly shows the widening of the joint space on the side of the injury.
[ Treatment of ruptures of the lateral ligaments of the knee joint
Indications for hospitalization
Treatment of the acute period of injury is carried out in a hospital.
Conservative treatment of ruptures of the lateral ligaments of the knee joint
In case of isolated rupture of one lateral ligament, conservative treatment is used. A puncture of the knee joint is performed, hemarthrosis is eliminated, 25-30 ml of 0.5% procaine solution is injected into the joint cavity. A plaster cast is applied for 5-7 days (until the edema disappears), and then a circular plaster cast is applied from the inguinal fold to the tips of the fingers in a functionally advantageous position and with excessive deviation of the shin (hypercorrection) towards the side of the lesion. UHF and static gymnastics are prescribed from the 3rd day. Immobilization lasts 6-8 weeks. After its elimination, restorative treatment is prescribed.
Surgical treatment of ruptures of the lateral ligaments of the knee joint
There are several methods of surgical restoration of the collateral ligaments of the knee joint.
Plastic surgery of the collateral tibial ligament. Ruptures of the collateral tibial ligament are more common than ruptures of the collateral fibular ligament. They are often combined with damage to the medial meniscus and anterior cruciate ligament (Turner's triad).
In the past, the Campbell procedure was most often used to restore stability to the knee joint in the event of a rupture of the collateral tibial ligament. The material used for the plastic surgery is a strip of the broad fascia of the thigh.
Subsequently, many methods of surgical restoration of the collateral tibial ligament were proposed: corrugation, ligament plastic surgery with lavsan, preserved tendon.
In 1985, A.F. Krasnov and G.P. Kotelnikov developed a new method of autoplasty of this ligament.
An incision is made in the soft tissues in the projection of the lower third of the tender muscle and its tendon is isolated.
In the area of the internal femoral epicondyle, a bone-periosteal flap is formed, and the tendon is moved under it. Then it is sutured to the periosteum at the entrance and exit. The flap is reinforced with transosseous sutures. The wound is sutured.
A circular plaster cast is applied from the fingertips to the upper third of the thigh for 4 weeks. The angle of flexion in the knee joint is 170°.
This operation compares favorably with previously used ones in that it is less traumatic and the technique is simple. The transplant under the bone-periosteal flap is securely fixed by tenodesis, which has been proven by clinical and experimental works of A.F. Krasnov (1967). The second fixation point at the tibia remains natural.
Plastic surgery of the collateral fibular ligament. In chronic cases, the stability of the knee joint with ruptures of the collateral fibular ligament is restored by its plastic surgery with auto- or xenomaterials. As a rule, preference is given to autoplastic interventions. An example is the Edwards operation, where the ligament is formed from a flap of the broad fascia of the thigh.
Along with the known methods of plastic surgery for ruptures of the collateral fibular ligament, the method of its autoplasty proposed by G. P. Kotelnikov (1987) is also used. It is used for ruptures of the collateral fibular ligament in patients with compensated and subcompensated forms of instability of the knee joint. In the case of decompensated instability, taking a transplant from the broad fascia is undesirable due to the sharp atrophy of the thigh muscles.
A 3x10 cm graft is cut out from the broad fascia of the thigh with the base at the outer condyle. In the region of the femoral epicondyle, an osteoperiosteal flap is formed with the base posteriorly to the width of the graft.
The second longitudinal incision 3-4 cm long is made above the head of the fibula. A channel is formed in it in the anteroposterior direction, keeping in mind the risk of damaging the common peroneal nerve. The graft is placed under the valve, stretched and passed through the channel. It is stitched at the entry and exit points. The bone-periosteal valve is fixed with transosseous sutures. The free end of the fascia is stitched to the graft as a duplicate. The wounds are sutured tightly. A plaster circular bandage is applied from the fingertips to the upper third of the thigh at an angle of 165-170° in the knee joint for 4 weeks.