LCL Sprain
Causes, Symptoms, Treatments, and Other Resources
Lateral collateral ligament (LCL) sprains are relatively less common compared to other knee ligament injuries, such as ACL (anterior cruciate ligament) or MCL (medial collateral ligament) tears.
They often occur as a result of sports-related activities. Sports that involve sudden changes in direction, pivoting, or direct blows to the knee can put individuals at a higher risk of LCL injury.
In this post, we’ll talk about the causes, symptoms, and treatment of LCL sprain.
Where in the Knee Is Your LCL?
To understand what an LCL sprain is, it is important to get an understanding of the anatomy of the knee.
Your knee comprises three bones: your thigh bone (femur), your kneecap (patella), and your shin bone (tibia).2 Ligaments act like pieces of duct tape to hold the joints in the body together.
There are two main types of knee ligaments:
- Collateral ligaments surround your knee. The inner medial collateral ligament (MCL) joins your femur and tibia. The outer, lateral collateral ligament (LCL) connects the femur and fibula. These are strong bands of connective tissue providing stability across a joint.
- Your cruciate ligaments are within the knee joint. The ACL crosses in front of the posterior cruciate ligament (PCL), forming an “X.” These ligaments regulate your knee’s backward and forward movements.
What Is an LCL Knee Sprain?
A sprain or tear to the lateral collateral ligament (LCL)3 is known as an LCL injury or LCL tear. The LCL is a band of tissue that runs along the outer side of your knee. It aids in keeping the bones together while you walk, ensuring your knee joint remains stable.
How you feel and what type of treatment is recommended depends on the severity of the injury. If it’s only a minor sprain and isolated to just the LCL, self-care at home might be all you need. However, if it’s a significant sprain or higher grade tear to the ligament, you may need physical therapy, an injection-based procedure, or surgery.
An LCL sprain and an LCL tear are often used interchangeably to describe levels of injury to the ligament, but in fact they are two different injuries.
Here’s how they differ:
- LCL tear: A tear usually refers to a more significant disruption or injury of the ligament fibers. LCL tears often occur due to a more significant force or trauma compared to a sprain.
Symptoms of an LCL tear may include severe pain, swelling, bruising, difficulty bearing weight, and a feeling of the knee “giving way.”
- LCL sprain: A sprain typically refers to a stretching or partial tearing of a ligament. In the case of an LCL sprain, it means that the LCL has been stretched beyond its normal range of motion, but the ligament is still largely intact. This is considered a milder form of injury compared to a tear.
What Causes LCL Knee Sprains?
An LCL sprain is caused by the following occurrences:
- A blow to the inside of the knee. The impact of the hit can stretch or tear the ligament along the outside edge of the knee. It’s prevalent among athletes who participate in sports such as football and hockey, in which players collide with one another.
- Shifting directions quickly or pivoting on one foot are examples of this. Soccer and basketball players may make sharp, sudden turns or stops, which can induce LCL damage. When a wrestler’s leg twists outward in a quick motion while they’re on the mat, their LCL may have been damaged.
- Landing badly or awkwardly from a jump may cause LCL damage. You can sprain your LCL during a basketball or volleyball game, skiing, or slipping on ice.
Symptoms of LCL Knee Sprains
Symptoms of an LCL sprain can vary, depending on the severity of the injury. Here are some common symptoms associated with LCL sprains:
- Pain: Pain is a primary symptom of an LCL sprain. The intensity of the pain can range from mild to severe, depending on the extent of the sprain.
- Swelling: Swelling around the area of the LCL is another typical symptom. This swelling occurs due to inflammation as the body responds to the injury.
- Tenderness: The area around the LCL may be tender to the touch. This tenderness can be felt along the outer side of the knee joint.
- Instability: An LCL sprain can lead to a feeling of instability or looseness in the knee joint. This can cause difficulty with activities that require stability, such as walking or changing direction.
- Difficulty bearing weight: Depending on the severity of the sprain, you may experience difficulty bearing weight on the affected leg. This can make it challenging to walk or put pressure on the knee.
- Limited range of motion: LCL sprains can result in a limited range of motion in the knee joint. You may find it difficult to extend or flex the knee fully.
- Bruising: In some cases, bruising may develop around the LCL or extend down the leg due to bleeding into the tissues.
Anterior Lateral Knee Pain
The knee joint is one of the most complex joints of the human body. The femur, the tibia, patella, and fibula all contribute to this joint. They are held together by a myriad of strong ligaments that stabilize and support the joint. Anterior lateral knee pain is pain that occurs in the anterior and the anterior lateral region of the knee joint. A person may experience this pain front and center, in the outer aspect of the knee, or diffusely throughout the joint. The cause of the pain is some pathology in the anterior and lateral aspect of the knee.
Read More About Anterior Lateral Knee PainFibular Head Pain
The proximal fibula is the part of the bone that lives just below the knee joint on the outside. It’s attached to the leg bone (tibia) via strong ligaments and there is a small joint here. There are many things that attach here, so it’s a critical point where pain can occur. There is a small joint between the fibula and the tibia known as the proximal tibiofibular joint. This is a plane-type joint which allows some sliding of the fibula on the tibia. It has cartilage just like the knee joint, so it can get arthritis which means worn down cartilage and bone spurs.
Read More About Fibular Head PainKnee Buckling
Knees can buckle, causing a sensation of one or both knees giving out that affects nearly 17% of adults. The knees are regarded to be one of the most essential (and biggest) joints in the human body because they play significant roles in basic activities such as walking and sitting. When our knees begin to feel unstable, weak, or begin giving out, it is easy to become stressed since we rely so heavily on them for movement. The knee can become stable from numerous types of injuries. The knee is kept stable by the following structures: Tendons attach the leg muscles…
Read More About Knee BucklingKnee Hurts When I Bend It and Straighten It
Your knees bend countless times throughout the day. Running up the stairs, down the hall after kids, and getting into the car. You straighten the knee as you walk, descend stairs or get into and out of the car. Bending and straightening the knee are necessary for daily activities. Knee pain with bending or straightening may be a mild, transient irritation or may indicate a more significant problem. Learn more below and avoid further injury and dysfunction. Knee pain can vary significantly depending upon many factors including the actual source of the pain, the severity of the injury, general health, and level of activity…
Read More About Knee Hurts When I Bend It and Straighten ItKnee Pain
Knee pain can be caused by many factors. Overuse injuries, direct trauma to the knee and arthritis are the most common causes of knee pain. Damage to the knee structures may cause swelling, scar tissue formation (fibrosis), and loss of function of the joint. Pain is often accompanied by difficulty walking, weakness, and instability. When the knee is overused, the thigh and shin bones (femur and tibia), cartilage, or tendons may experience stress. This leads to pain and discomfort as well as stiffness in the knee. Overuse injuries are common among athletes who participate in sports that involve running, jumping…
Read More About Knee PainKnee Popping
Knee popping can be a sensation that something is moving around in the knee. There may also be an audible sound associated with the popping, which in medical terms is called crepitus. This can also cause what we call mechanical catching or locking, which may make the knee feel like it is stuck in an extended or flexed position, and you have to move it in certain ways to get out of that. This knee popping sensation or sound or could be a very simple issue or it could be a sign that more serious damage is going on in the knee, so determining what is causing it is very important. So, the knees may pop and get in a certain position….
Read More About Knee PoppingKnee Swelling
Swelling of the knee, also known as water on the knee, is a condition in which fluid collects around the knee joint. Swelling can occur for a variety of reasons and affect patients of any age. Some swelling can be treated with over-the-counter medicines, but persistent and continuous swelling might result in tissue damage, bone softening, and cartilage deterioration. Over-the-counter medicines will assist relieve pain for individuals with a history of osteoarthritis and swelling following physical activity, such as exercise or running. During and after activity, the patient may apply compression sleeves to reduce the inflammation. Ice is another method…
Read More About Knee SwellingLoose Knee Joint
Ligaments are fibrous bands that connect the bones together. If the ligaments inside your knee become damaged, your knee could feel loose (with or without pain). While walking, exercising, or simply standing, it may feel like your knee could collapse at any moment. If the knee muscles are damaged, they will be unable to contract properly, resulting in lack of strength and discomfort. Swelling might have a similar result. What Causes Laxity in the Knee Joint? Knee injuries are generally sports-related, although they may occur during any physical activity that puts stress on the knee and causes bending or trauma…
Read More About Loose Knee JointOutside Knee Pain
What causes outside knee pain? How do you treat it? Let us go over all of this and also review how one patient avoided a huge surgery. What is On the Outside of the Knee? You have a couple of key structures here (1). They include the: Lateral meniscus, Lateral joint compartment, Popliteus tendon, Iliotibial band, Lateral collateral ligament , and anterolateral ligament, and Fibula. The meniscus is a figure-8 shaped fibrous structure (shown here from above) that is a shock absorber for the knee joint. It has an outside part (lateral meniscus) that cushions the joint. The meniscus can become torn or degenerated. If you are young…
Read More About Outside Knee PainTightness in Knee
What could tightness in your knee mean? When fluid builds up inside the knee as a result of an injury, overuse, or medical problem, the knees become swollen and tight. Swelling might be mild, so you may not always notice it unless it is serious damage. You may feel this as stiffness in the knee since swelling may not be visible. Swelling restricts movement since there is less room in the knee. Fluid buildup can be caused by irritation, internal bleeding, and injuries to the knee. Arthritis, gout, tumors, and baker cysts are all causes of swelling. Pain and swelling are the responses of your body to damage. Together they can lead to stiffness in your knee…
Read More About Tightness in KneeWeak in Knees
Weakness in the knee can be a symptom of many different knee conditions. Some of the most common causes of weakness in the knee include ligament tears, meniscus tears, and arthritis. Another important but often overlooked cause of knee weakness is irritation or injury of the nerves in the low back. If you are experiencing any type of weakness in your knee for long durations of time (3 weeks), it is important to see a doctor to determine the cause. Some of the most common symptoms of knee weakness include difficulty standing up from a seated position, difficulty walking, climbing or descending stairs…
Read More About Weak in KneesDiagnosis and Examination
Diagnosing and treating an LCL sprain typically involves a combination of medical evaluation, physical examination, and imaging tests. Here are the general steps involved in diagnosing an LCL sprain:
- Medical evaluation: Begin by consulting a healthcare professional, such as an orthopedic specialist or sports medicine doctor. They will review your medical history, discuss the circumstances of the injury, and ask about your symptoms.
- Physical examination: The doctor will perform a physical examination of your knee to assess its stability, range of motion, and any signs of tenderness or swelling. They may also evaluate other structures of the knee to rule out additional injuries.
There are specific physical examination techniques that healthcare professionals use to assess for an LCL sprain. These techniques help determine the stability and integrity of the LCL and aid in the diagnosis.
Here are some common physical examination tests for LCL sprains:
Varus Stress Test
The varus stress test is the primary test used to assess the integrity of the LCL.1
Here’s how it’s performed:
- You will lie on your back on an examination table with your legs straight.
- The healthcare professional will stabilize your thigh with one hand while applying a sideways force to the lower leg, pushing it inward.
- They will assess the degree of movement and any pain or instability felt along the outer side of the knee, which stresses the LCL.
- This test can also be performed under diagnostic ultrasound to visualize the integrity of the LCL and lateral joint line.
A positive varus stress test indicates increased or excessive movement on the outer side of the knee, suggesting an LCL sprain or injury.
Palpation
The healthcare professional may palpate (feel) around the knee joint to assess for tenderness, swelling, and localized pain. They will specifically check the lateral (outer) side of the knee where the LCL is located.
Imaging Tests
To confirm the diagnosis and assess the severity of the LCL sprain, the doctor may order imaging tests, such as an MRI (Magnetic Resonance Imaging).
The MRI can provide detailed images of the ligaments and other structures in the knee, helping to determine the extent of the sprain and identify any associated injuries. In addition, a doctor experienced in diagnostic ultrasound can utilize this real-time, dynamic imaging tool to assess in-office.
Treatment Options
LCL sprains have many treatment options. These range from conservative, non-medical treatments to surgery. There are various regenerative therapies as well. They are explained in detail below.
Physical Therapy
Physical therapy can consist of many options to decrease pain and increase the range of motion at the knee. A physical therapist may also suggest bracing to support the knee during activities that cause pain so that you do not have to worry about the pain as much.
Physical therapy is beneficial for LCL injuries because it can address biomechanical deficiencies associated with movement and helps strengthen muscles around the knee so they can stabilize it more efficiently.
Surgery
Different types of surgery can be done for LCL tears. The most common type of surgery is arthroscopic repair.
In this surgery, a small incision is made and a tiny camera is inserted into the knee joint to view the tear. The camera will help the surgeon see what needs to be repaired and they will fix it with small instruments.
Other types of surgery that can be done for LCL tears include:
- LCL reconstruction
- Open repair
- Arthrodesis
An LCL reconstruction is a more extensive surgery and requires the surgeon to use a graft. This type of surgery can be done through an open incision or arthroscopically. If it is done through an open incision, the entire knee will need to be opened. If it’s done arthroscopically then it will be similar to an arthroscopic repair.
Arthrodesis is the permanent fixation of the knee, which would require cutting out the ligament and fusing two bones, thus creating one completely rigid structure. This is usually reserved for severe cases involving other structures of the knee, as it completely changes the anatomy and function.
Nonsurgical Treatment Options
Nonsurgical treatment options for LCL sprains include rest, ice, compression and elevation (RICE), NSAIDs (non-steroid anti-inflammatory drugs), corticosteroid injections, prolotherapy, and PRP injection treatment. If the injury is more acute in nature (under a few weeks in duration) then RICE may be all that is needed to allow the ligament time to heal.
NSAIDs can help reduce inflammation and pain. If the injury is more than two weeks old, then a cortisone injection may be recommended.
However, at the Centeno-Schultz Clinic, we recommend skipping the cortisone shot due to its inhibitory effects on stem cells and growth factors around the injury. The Centeno-Schultz Clinic specializes in utilizing your own growth and healing factors to help support your own natural healing processes.
Platelet-rich plasma (PRP) therapy involves the extraction and concentration of platelets from the patient’s own blood. These platelets contain growth factors that can potentially stimulate tissue healing and regeneration. In PRP therapy for LCL sprains, the concentrated platelet solution is injected into the injured areas to promote tissue repair and reduce chronic inflammation.
Knee Arthroscopy Surgery
Knee arthroscopy surgery is a very common procedure performed by orthopedic surgeons in an attempt to treat knee pain. Knee arthroscopic surgery is typically performed in an outpatient surgical facility where a small camera is inserted into the knee joint, which allows the surgeon an inside view of one’s knee to operate. It is used both to diagnose and treat a wide variety of knee problems. Utilizing arthroscopic surgery the surgeon can trim any damaged ligaments which are called knee ligament surgery. Alternatively, if ‘damaged’ meniscus is detected, it also is trimmed and or removed, which is called meniscus knee surgery.
Read More About Knee Arthroscopy SurgeryKnee Ligament Surgery
Knee ligament surgeries have become quite common, ACL (anterior cruciate ligament) surgeries average 250,000+ surgeries alone every year! These invasive surgeries have come under investigation in recent years, wondering the necessity, or need to be done. Your knee has 3 points of contact or compartments that house the cartilage of your knee: the patella-femoral compartment, lateral (outside) compartment, medial (inside) compartment. These compartments are held together by a network of ligaments that hold each bone together and allow the knee to move properly. The main knee ligament surgery…
Read More About Knee Ligament SurgeryNSAIDs
The other day I was evaluating a patient and reviewing the treatment options for their spine condition. After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…
Read More About NSAIDsProlotherapy Injections
It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…
Read More About Prolotherapy InjectionsPRP Injections
PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…
Read More About PRP InjectionsPRP Knee Injections
PRP stands for Platelet-Rich Plasma. Platelets are blood cells that prevent bleeding. They contain important growth factors that aid in healing. Plasma is the light yellow liquid portion of our blood. So PRP is simply a concentration of a patient’s own platelets that are suspended in plasma and are used to accelerate healing. PRP is NOT stem cell therapy. Regrettably, blood contains few circulating stem cells. Rich sources of stem cells are bone marrow and fat. PRP is rich in growth factors. There are many different types of growth factors with different properties. VEGF is a very important one as it can increase the blood flow to an area.
Read More About PRP Knee InjectionsLong-Term Outlook
The long-term outlook or prognosis for LCL sprains can vary depending on several factors, including the severity of the sprain, the presence of associated injuries, the individual’s age and overall health, and the effectiveness of treatment and rehabilitation.
Here are some general points regarding the long-term outlook for LCL sprains:
- Mild to moderate sprains: Mild to moderate LCL sprains, typically categorized as Grade 1 or Grade 2, generally have a good prognosis with conservative management.
With appropriate rest, rehabilitation, and physical therapy, individuals can often recover well and regain normal function and stability in their knee joints.
- Severe sprains: Severe LCL sprains, categorized as Grade 3, involving complete tearing or rupture of the ligament, may have a more variable prognosis. These severe sprains can result in significant instability of the knee joint, and there may be a higher likelihood of associated injuries, such as meniscus tears or ACL tears.
In some cases, surgical intervention, such as LCL reconstruction, may be required to restore stability to the knee joint.
- Rehabilitation and physical therapy: The success of rehabilitation and physical therapy plays a crucial role in the long-term outlook for LCL sprains. A comprehensive rehabilitation program is important for restoring strength, stability, and range of motion to the knee joint.
Adhering to the prescribed exercises and following the guidance of a physical therapist can significantly improve the prognosis and functional outcomes.
- Associated injuries: The presence of associated injuries, such as ACL tears or meniscus tears, can influence the long-term prognosis for LCL sprains. These additional injuries may require specific treatments or surgical interventions, and their management can impact the overall recovery and outcome.
- Individual factors: Each individual is unique, and factors such as age, overall health, compliance with treatment and rehabilitation, and adherence to activity modification guidelines can influence the long-term prognosis.
Following correct post-treatment care, maintaining a healthy lifestyle, and taking steps to prevent further injury are essential for optimal outcomes.
Your LCL Sprain Is Treatable
LCL sprains can be easily treatable with the right medical attention, especially without invasive surgery. With appropriate rehabilitation and time for healing, the ligament can repair itself and regain stability without surgical intervention. Non-surgical treatments such as PRP or bone marrow concentrate typically involve less downtime and allow for a faster recovery compared to surgery.
Conservative management allows individuals to resume their daily activities and sports participation sooner, reducing the overall impact on their lifestyle and routine.
Ready to get help for your LCL sprain? Download our Knee Owner’s Manual today!
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
Read moreJohn Schultz, MD
John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…
Read moreJohn Pitts, M.D.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Read moreJason Markle, D.O.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Read moreBrandon T. Money, D.O., M.S.
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
Read moreOther Resources for LCL Sprain
Free Download: The Knee Owner’s Manual
This e-book by Dr. Chris Centeno examines the knee and its role in the human musculoskeletal system and the body as a whole. The Knee Owner’s Manual provides a series of tests and clearly defined exercises that you can perform on your own to assess and monitor your own knee health. It will allow you to look for trouble spots where your own body may be having difficulty with stability, articulation, symmetry, and neuromuscular function. You’ll be able to see how these deficits in other regions of the body relate to the knee.
The Knee Owner’s Manual also discusses how Regenexx is pioneering the development of interventional orthopedics, a new branch of medicine that employs regenerative biologic therapies such as adult bone marrow concentrate and platelet-rich plasma to help repair and strengthen damaged tissues in other areas of the body.
This is contrasted with invasive knee surgeries, which often remove important tissues or replace the entire knee itself when it becomes damaged. With hyperlinks to more detailed information, related studies, and commentary, this book condenses a vast amount of data, images, and resources into an enjoyable and informative read. This is the first edition of The Knee Owner’s Manual, a companion book to Orthopedics 2.0.
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References
- Yaras RJ, O’Neill N, Yaish AM. Lateral Collateral Ligament Knee Injuries. [Updated 2022 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560847/
- Lehrbuch Anatomie, L. H., Urban und Fischer, & München. [created 2020 August 13]. How does the knee work? essay, IQWiG. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK561512/
- Cleveland Clinic. (Updated 2023 August 28). Knee ligaments: Anatomy, ACL, MCL, PCL, LCL, torn ligament. https://my.clevelandclinic.org/health/body/21596-knee-ligaments