Isolated Clinically Diagnosed Grades 1-2 Lateral Collateral Ligament Injuries in Elite Athletes Do Not Require Surgery.

Background: Lateral collateral ligament (LCL) injuries can occur in isolation or as part of more extensive posterolateral corner (PLC) injury. Although excess laxity due to PLC injury is usually considered an absolute indication for repair or reconstruction, nonoperative management of isolated LCL injuries is also possible. Purpose/Hypothesis: The purpose of the present study is primarily to evaluate the outcome of nonoperative treatment in a consecutive series of isolated LCL injuries in elite athletes as reflected by successful return to play (RTP), performance level, and rates of continued play at 2 and 5 years after injury. Furthermore, it was hypothesized that the clinical and radiological grading of LCL injuries do not correlate. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of elite athletes with PLC injury of the knee treated by 2 sports knee surgeons between January 2015 and June 2021 was identified. Only those with isolated LCL injuries as identified on magnetic resonance imaging (MRI) and by a lack of any abnormal rotatory laxity were included. Data pertaining to clinical examination findings, radiological findings, treatment, RTP times, performance levels, and subsequent career longevity were collected. Results: A total of 55 professional athletes (44 soccer players), with a mean ± SD age of 24.3 ± 4.5 years, with MRI-confirmed isolated LCL injuries were included in final analysis. Of the total cohort, clinical examination findings were notable for grade 0 laxity in 7 (12.7%) athletes, grade 1 in 42 (76.4%), grade 2 in 6 (10.9%), and grade 3 in 1 (1.8%). All patients were treated with restricted activities and rehabilitation. MRI grading and clinical grading showed low correlation (r = 0.37; P = .01). RTP was 100% at a mean of 103 (0-422) days (median of 76 days [2.5 months]). At 2 years, 51 athletes (92.7%) were still playing elite sport. At 5 years, participation among the 32 athletes still playing in elite sport reduced to 84.4% (n = 27 players). All athletes returned to their preinjury level of play. No athletes stopped elite sport secondary to their LCL injury. Conclusion: The current data suggest that nonoperative management of isolated clinically diagnosed grades 1 and 2 LCL injury is associated with high return to preinjury level of sport (100%), reasonable recovery times (median of 76 days), and no significant residual varus laxity. There was low correlation of MRI grade of isolated LCL injury with clinical examination findings. The authors recommend these lesions be treated without surgery.