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The knee is the body's largest joint, and it is also one of the most frequently injured. The knee joint is made up of bones, cartilage, muscles, ligaments, and nerves. The knee is a synovial joint, which means it has the most freedom of movement. The knee's hinge-like action enables the legs to straighten and bend, which is necessary for walking, climbing and descending stairs, running, and jumping. The knee's primary muscles, the quadriceps, are a group of four muscles that sit at the front of the thigh and are responsible for allowing the knee to straighten. The lateral collateral ligament (LCL) is the ligament on the outside of the knee, and it provides stability to the knee from the outer side.
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What You'll Learn
Lateral collateral ligament (LCL) injuries
The knee is the body's largest joint, and one of the most commonly injured. It is a synovial joint, allowing for a wide range of motion. The knee is made up of bones, cartilage, ligaments, and tendons. The lateral collateral ligament (LCL) is a vital band of tissue on the outside of the knee. It connects the femur (thighbone) to the fibula (the smaller bone in the lower leg). The LCL is one of the knee joint's major stabilisers, preventing excess varus and posterior-lateral rotation of the knee.
LCL injuries are less frequent than other ligament injuries, but they are most commonly seen in sports with high-velocity pivoting and jumping, such as soccer, basketball, skiing, football, and hockey. Athletes who participate in direct contact sports are more likely to injure their LCL. The LCL can be injured by a non-contact varus stress or non-contact hyperextension, or by a high-energy blow to the anteromedial knee, combining hyperextension and extreme varus force.
The symptoms of an LCL injury include pain, swelling, bruising, and stiffness with end-of-range flexion or extension. There may also be overall weakness and possible instability. LCL tears can cause athletes to be benched for three to twelve weeks, or even longer. If the ligament has pulled directly off the bone, surgery may be recommended. However, if the LCL is the only structure in the knee that has been injured, treatment can be similar to an MCL sprain, involving rest, rehabilitation, and bracing.
To prevent LCL injuries, athletes can wear a knee brace, stretch before practices or games, and do conditioning exercises to improve strength and flexibility.
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Iliotibial band syndrome
The iliotibial band can become irritated when it is stretched too tight, causing it to rub against the lateral epicondyle on the outside of the knee. This can lead to symptoms such as stiffness, aching, and burning pain on the outside of the knee and hip. As the syndrome progresses, the pain can become sharper and more constant, even during rest. ITBS can be diagnosed through a physical examination, including specific tests such as the Ober test, which indicates a short or tense iliotibial band.
Treatment for ITBS typically involves rest, physical therapy, and a gradual return to activity. Physical therapy focuses on stretching and strengthening the iliotibial band and surrounding muscles. Anti-inflammatory medications may also be recommended to reduce pain and inflammation. In rare cases, if non-surgical treatments fail, arthroscopic or open surgery may be required to remove inflamed soft tissue.
Individuals with certain traits or conditions may have a higher risk of developing ITBS. These include having bowed legs, one leg longer than the other, knee arthritis, weak hip or buttock muscles, and frequent participation in high-impact sports. ITBS is more commonly diagnosed in females than males and is often observed in young, active individuals.
ITBS can cause significant knee pain and discomfort, but with proper management and treatment, most patients can recover within 6 weeks and gradually resume their regular activities.
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Quadriceps and patellar tendon injuries
The knee is the body's largest joint and is also one of the most frequently injured. The knee joint is made up of bones, cartilage, muscles, ligaments, and nerves. The patellar tendon and the quadriceps tendon are two tendons that are susceptible to injury.
Patellar Tendon Injuries
The patellar tendon is located just below the kneecap (patella). It connects the kneecap to the shinbone (tibia). Patellar tendon tears occur when the quadriceps tendon contracts suddenly, with force exceeding the tendon's capacity. This can happen when jumping or falling on a flexed knee. A patellar tendon rupture is characterised by acute pain around the kneecap, often accompanied by a popping noise and significant swelling. Patients will experience difficulty extending the knee and walking.
Quadriceps Tendon Injuries
The quadriceps tendon is located just above the kneecap and connects the quadriceps muscles in the front of the thigh to the top of the kneecap. Quadriceps tendon tears can occur in a similar manner to patellar tendon tears, when the tendon contracts suddenly with excessive force. A quadriceps tendon rupture will result in the kneecap sitting slightly lower than normal (patella baja).
Tendinopathy
Tendinopathy is an overuse injury caused by repeated and prolonged stress on a tendon, leading to tiny tears in the tendon. This can result in pain and dysfunction, particularly during activities that involve deep knee flexion. Treatment of tendinopathies involves controlled tendon loading programs to reduce pain and promote remodeling.
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Knee flexors and extensors
The knee is the body's largest joint, and it is also one of the most frequently injured. Bones, cartilage, muscles, ligaments, and nerves are all found in the knees. The knee is a synovial joint, which means it has the most mobility. The knee's primary function is to support the body's weight and enable leg movement. The knee's ability to bend and straighten is essential for activities such as walking, ascending and descending stairs, rising from a seated posture, running, and jumping.
The knee flexors are the muscles that pull the knee in. The following are included in this group:
- Articularis genus
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
- Hamstrings
- Sartorius
- Gracilis
- Gastrocnemius
- Plantaris
- Popliteus
The hamstrings are the primary knee flexors, and they are essential in daily activities such as walking and running. The biceps femoris, semitendinosus, semimembranosus, and gastrocnemius are the four muscles that make up the hamstring group. The hamstrings also perform hip extension, except for the short head biceps femoris.
The knee extensors are the muscles that work in opposition to the flexors, allowing the knee to extend. The following are included in this group:
- Biceps femoris
- Semitendinosus
- Semimembranosus
- Gastrocnemius
The quadriceps femoris, which is made up of four muscles, is the only extensor component of the knee joint. The rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis are the four muscles that make up the quadriceps femoris. The quadriceps femoris is one of the most powerful muscles in the body. The knee extensors are essential for daily activities such as climbing stairs, getting up from a chair, and walking, as well as sports such as jumping, cycling, running, and basketball.
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Crucial knee ligaments
The knee is the body's largest joint and is one of the most frequently injured. It is a synovial joint, which means it has the most freedom of movement of all joints. The knee contains bones, cartilage, muscles, ligaments, and nerves. The four main ligaments in the knee are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). These ligaments connect the femur (thighbone) to the tibia (shinbone) and provide stability to the knee.
The two collateral ligaments are like straps on each side of the knee, preventing it from moving side to side. The MCL is on the inner side, while the LCL is on the outer side, providing stability to the outer knee. The LCL is thinner and rounder than the MCL and connects the femur to the fibula (the smaller lower leg bone).
The two cruciate ligaments are located in the centre of the knee. They prevent the knee from shifting too far forward or backward. The ACL is one of the most commonly injured ligaments in the knee, often stretched or torn during a sudden twisting motion. It is located inside the knee and crosses to the front, connecting the femur to the tibia. The PCL is located inside the knee and crosses to the back, controlling the backward movement of the tibia.
The meniscus is another important structure in the knee, consisting of two thick, rubbery pieces of cartilage that sit between the femur and tibia. The lateral meniscus is on the outer side of the knee and is susceptible to tears during sudden twisting motions.
Injuries to the ligaments and tendons of the knee are a common cause of lateral knee pain. The patellar tendon and quadriceps tendon are prone to injuries such as ruptures, tears, and tendonitis.
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Frequently asked questions
Outer knee pain, also known as lateral knee pain, is pain on the outer side of the knee.
Lateral knee pain can be caused by several conditions, including injuries to the ligaments and tendons, arthritis, inflammation, and bone contusions.
Treatment for outer knee pain depends on the underlying cause. It may include physiotherapy, surgery, or medications to manage pain and inflammation.
A lateral collateral ligament (LCL) injury occurs when the outer side of the knee is stretched or subjected to a blow, resulting in ligament damage. The LCL is located on the outside of the knee and provides stability to the joint.
