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Isolated Lateral Collateral Ligament Injuries Encountered in Combat Sports: What is the Optimal Treatment?


Nicole Danielle Rynecki, MD
UNITED STATES

Isolated Lateral Collateral Ligament Injuries Encountered in Combat Sports: What is the Optimal Treatment?

Nicole Danielle Rynecki, MD, UNITED STATES Kunj Jain, BS, UNITED STATES Harsh Shah, MD, UNITED STATES Robin M. Gehrmann, MD, UNITED STATES

New Jersey Medical School, Newark, NJ, UNITED STATES

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Tears

Treatment / Technique

Repair / Reconstruction

Ligaments

LC Ligament

Patient Populations

Sport Specific Population

Diagnosis Method

Physical Examination X-ray MRI

Sports Medicine

Sport Specific Injuries

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Summary: An algorithm for the management of isolated LCL tears in combat sports based on grade of tear: minimizing time to return to sport while maximizing patient-reported outcomes.

Introduction

Isolated injury to the lateral collateral ligament (LCL) without concomitant posterolateral corner injury is a rare injury but appears to be fairly common in mixed martial arts (MMA) and Brazilian Jiu Jitsu (BJJ). The goal of this study was to determine how best to treat isolated LCL injuries and optimize patient-reported outcomes.

Methods

A retrospective review of eleven patients (twelve knees) who sustained isolated LCL injuries while participating in MMA or BJJ evaluated by the senior author between 2011 and 2019 was performed. Diagnoses were confirmed clinically and through magnetic resonance imaging (MRI). All patients were evaluated at their initial and last follow-up appointment with the International Knee Documentation Committee (IKDC) and Lysholm knee subjective scoring forms.

Results

Eleven males aged 35.3 years old (27 - 46) sustained isolated LCL injuries through a varus force placed on the knee. Average follow-up was greater than 2 years. Nine patients were treated nonoperatively. Three of these patients had grade I LCL tears, five had grade II LCL tears, and one had a grade III LCL tear. For seven of the nine patients, this consisted of six weeks in a hinged knee brace with full withdrawal from training, followed by light training at the six-week mark, and clearance to return to unrestricted training at the three-month mark. Two patients returned to unrestricted training at the ten-week mark. Average IKDC and Lysholm scores for patients treated nonoperatively increased from 40.7 and 52.7 to 93.7 and 86, respectively. For grade I injuries, there was a 48.7 and 45.7-point improvement on the IKDC and Lysholm scoring forms, respectively. For grade II injuries, there was a 58.3 and 38.0-point improvement on the IKDC and Lysholm scoring forms, respectively. The patient treated nonoperatively for his grade III LCL tear reported an 18.4 and 12-point improvement on his IKDC and Lyholm scoring forms, respectively. Three of four patients with grade III LCL tears and varus stress radiographs with >2.7 side-to-side gapping underwent LCL reconstruction using semitendinosus allograft tissue. Average return to competition was at 28 weeks (24 - 36 weeks). Final IKDC and Lysolm scores post-reconstruction were 94.3 and 89.3, respectively. One patient, who sustained bilateral grade III LCL tears three years apart, opted for operative treatment on his first LCL tear and nonoperative treatment on his second, contralateral LCL tear. To date, he continues to report recurrent episodes of instability and has since sustained a medial meniscus and grade II ACL tear on his nonoperative knee.

Discussion And Conclusion

Submission maneuvers and fight techniques in MMA and BJJ may predispose athletes to isolated LCL injuries. Patients with grade I and II LCL tears may be treated nonoperatively, with quicker return to play. Patients with grade III tears appear to benefit from surgical reconstruction to restore stability in the lateral compartment and may return to competition as early as six months. This treatment algorithm resulted in a significant improvement in patient reported outcomes in our patient set. We observed one patient with asynchronous, bilateral grade III LCL tears, who had suboptimal outcomes and a subsequent medial meniscus and grade II ACL tear on his nonoperative knee. This further supports the benefits of surgical restoration of the primary varus stabilizer of the knee in the setting of a complete tear. Observation of a single patient limits drawing conclusions, but it is an important direction for future investigations.

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