2025 ISAKOS Biennial Congress ePoster
Isolated Lateral Collateral Ligament Injuries In Elite Athletes Do Not Need Surgery
David Johannes Haslhofer, MD, Linz AUSTRIA
Matthew KJ Jaggard, MD, PhD, Cambridge UNITED KINGDOM
Wahid Abdul, BSc(Hons), MBBCh, MRCS, FRCS(Tr&Orth), MSc(SEM), Exeter UNITED KINGDOM
Mary Jones, MSc, Grad. Dip. Phys., Richmond, Surrey UNITED KINGDOM
Justin Lee, MB BS, FRCR, London UNITED KINGDOM
Simon Ball, MA, FRCS(Tr&Orth), London, Middlesex UNITED KINGDOM
Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), London UNITED KINGDOM
Fortius Clinic, London, UNITED KINGDOM
FDA Status Not Applicable
Summary
Truly isolated LCL injury, which most commonly affects soccer players, even with high grade lesions reported on MRI (80% grade 2 and 3), managed with non-operative treatment have excellent outcome: 100% return to play at pre-injury level or better, short recovery (median 76 days), no instability symptoms, and normal career longevity (84.4% playing at 5 years).
ePosters will be available shortly before Congress
Abstract
Background
Posterolateral corner (PLC) injuries with excess laxity are usually considered an absolute indication for repair or reconstruction, irrespective of which components of the PLC are injured. A spectrum from pure varus laxity, due to isolated LCL lesions, to pure posterolateral rotatory laxity from isolated popliteus complex (including popliteo-fibular ligament) lesions occur, but most are a combination.
Hypothesis/Purpose:
The aim of the present study is to illustrate the success of non-operative treatment of isolated LCL injuries, including complete lesions, in elite athletes as reflected by successful return to play, performance level, and rates of continued play at two- and five-years post injury. The largest consecutive case series of non-operatively managed isolated LCL injuries in any patient group is presented.
Material And Methods
A consecutive series of elite athletes with injuries to the posterolateral corner (PLC) of the knee treated by two sports knee surgeons between 2015 and 2022 was identified. Only those with isolated LCL injuries were included. The following data was collected: clinical examination findings, radiological findings, return to play times, performance levels, and subsequent career longevity.
Results
Fifty-five professional athletes (44 soccer players) with MRI confirmed isolated LCL lesions and a mean age of 24.3 years (± 4.5 years) were included. Clinical laxity excess was grade 3 in 1 athlete, grade 2 in 6 athletes, and grade 1 in 42 athletes and 0 in 7 athletes. All patients were treated with restricted activities and rehabilitation. MRI grading and clinical grading showed low correlation in our cohort (r = 0.37, p = 0.01). Return to play (RTP) was 100% at a mean of 103 days / median 76 days (0-422 days). At 2 years, 51 athletes (92.7%) were still playing elite sport. 84.4% (27 of 32 players) were still playing elite sport at 5 years. All played at pre-injury level. No athlete stopped elite sport due to the consequences of the LCL injury.
Conclusion
Truly isolated LCL injury, which most commonly affects soccer players, even with high grade lesions reported on MRI (80% grade 2 and 3), managed with non-operative treatment have excellent outcome: 100% return to play at pre-injury level or better, short recovery (median 76 days), no instability symptoms, and normal career longevity (84.4% playing at 5 years). These lesions should not be treated surgically.
Furthermore, the correlation of MRI grade of isolated LCL injury with clinical examination grading is low.