Tear > Treatments
Preparing for Surgery
The decisions you make and the actions you take
before your surgery can be every bit as important as
the procedure itself in ensuring a healthy recovery.
Some insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your lateral collateral ligament surgical repair. If
your surgery is going to be inpatient, there may be
a separate department, so be sure to ask your doctor.
After you have checked in to the hospital or clinic,
you will go to a holding area where the final preparations
are made. The paperwork is completed and your knee area
may be shaved (this is not always necessary). You will
wear a hospital gown and remove all of your jewelry.
You will meet the anesthesiologist or nurse anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
anesthesia, which can lead to pneumonia.
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Surgical repair of a torn LCL (lateral
collateral ligament) usually takes about one to two
hours, but can be longer if there are other injuries
to the knee that also require surgery, such as an ACL
(anterior cruciate ligament) tear.
anesthesia is typically used for this surgery, though
in some cases a spinal or epidural anesthetic is used.
The anesthesiologist will administer the anesthesia
to put you to sleep once you are in the operating room.
surgeon will make a three- to six-inch incision on the
outside (little-toe side) of the knee.
the LCL has been torn where it attaches to the thighbone
(femur) or shinbone (tibia), the surgeon will re-attach
the ligament to the bone using large sutures or a metal
the tear occurred in the middle of the ligament, the
surgeon will repair the ligament by sewing the torn
ends together using sutures.
are sewn up and the patient is taken to the recovery
Following surgical repair of your LCL, you usually
stay in the recovery room for at least two hours while
the anesthetic wears off. You will be given adequate
pain medicine, either orally or through an IV (intravenous)
line, as well as instructions for what to do over the
next couple of days. In addition, you will be given
an appointment to return and a prescription for pain
medicine. When you wake up, your knee will be bandaged
and may have ice on it. You may have significant pain
early on and you should take the pain medicine as directed.
Remember that it is easier to keep pain suppressed than
it is to treat pain once it becomes present. When you
feel the pain coming on, take another pill. You are
safe as long as it is within the time limit on the bottle.
You should try to move your feet while you are in the
recovery room to improve circulation. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse, who, with the assistance of the doctor, will
determine when you are ready to leave the hospital or,
if necessary, be admitted for an overnight stay. It
is likely that you will be able to bear some weight
on your leg, but your surgeon may suggest that you use
crutches or a cane for a couple of days. For most people,
crutches are used only until you feel steady on your
feet. As soon as you are fully awakened, you are usually
allowed to go home. You will probably be unable to drive
a car, so be sure to have arranged a ride home.
Post-op in Hospital
After LCL (lateral collateral ligament) surgical repair,
some patients remain in the hospital for as long as
24 hours. As soon as possible after surgery is completed,
you will begin doing continuous passive motion exercises
while in bed. Your leg will be flexed and extended to
keep the knee joint from becoming stiff. This may be
done using a continuous passive motion (CPM) machine.
The CPM is attached to your bed and then your leg is
placed in it. When turned on, it takes your leg through
a continuous range of motion. There will likely be pain,
and you can expect to be given pain medication as needed.
Be sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
Ice also helps control pain and swelling.
After surgical repair of your LCL (lateral
collateral ligament), you will need to take steps to
reduce the pain and inflammation in the knee. Rest,
icing, elevation, and pain relievers such as aspirin
or ibuprofen can ease pain and swelling, and immobilizing
the knee will keep it stabilized. To protect the repair,
your physician may recommend that you wear a lightweight
cast or brace that will allow your knee to flex and
extend but restricts side-to-side movement, for up to
three months. The length of time depends on the overall
alignment of your leg bones, your weight, and any associated
injuries. Initially, you may be prescribed a cast or
brace that will not allow you to bend your knee. This
period of immobilization may last from three days to
a maximum of one month. If your leg is immobilized,
you will need to avoid having to squat, kneel down,
or bend over. You should try to keep your leg elevated
even if you are sitting in a chair, to reduce blood
flow to the knee. Depending on the success of the above
measures in reducing pain and swelling, you may be able
to start on a rehabilitative program after a few days.
to call the doctor after surgery
pain and swelling have subsided, you should be able
to begin exercises to restore strength and normal range
of motion to your knee. Though the ligament tissues
are weak after surgery, they are generally strong enough
to handle mild stretching and slow movements. Working
to restore early range of motion may help reduce swelling
and stiffness, and speed your healing time. During your
rehabilitation, you should try to avoid any twisting,
bending, or hyper-extending your knee. If you are still
experiencing soreness while you are doing exercises,
you should proceed cautiously to prevent further irritation.
Rehab progresses into strengthening exercises that focus
on the quadriceps and hamstrings Ð the main stabilizing
muscles for your knee. Physicians suggest you gradually
increase the amount of weight as your leg muscles get
stronger. Strengthening exercises require dedication
because results often take weeks and pain may recur.
Once the muscles of your injured leg are about as strong
as the uninjured leg, the focus of rehab turns to increasing
your coordination. Physical therapy tends to become
activity-oriented as you regain the ability to perform
complicated movements. Once an LCL tear has fully healed,
you should have a minimum of long-term effects.
strengthening exercises: Ligament injuries
Though collateral ligament injuries often
occur during sports and are difficult to avoid, there
are several steps you can take to improve the overall
strength and flexibility of your knee:
your weight. Every pound in excess of your normal weight
puts three or four additional pounds of pressure on
your knee every time you take a step.
hamstrings, in the back of the thigh, and quadriceps,
the muscles in the front of the thigh, are crucial shock
and impact absorbers. These muscles must be kept strong
and flexible to protect the joint surfaces in your knee.
before exercising should be a regular part of your warmup;
however, it is important not to over-stretch. Never
push or pull on your leg with your hands while you are
stretching, and avoid squatting during your warmup,
which can put stress on your knee joint.
well-fitting athletic shoes can reduce the impact of
the load exerted on the knee.
you are engaging in activities that require a lot of
twisting and turning such as racket sports, skiing,
soccer, and basketball, do not assume you can play yourself
into shape; make sure you are in good physical shape
before you play.