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 MCL (medial 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 MCL (medial
collateral ligament) is usually performed through a
small incision on the inside (big-toe side) of your
knee. It is not done arthroscopically, since this ligament
is not actually within the knee joint. The procedure
usually takes one to two hours, depending whether other
ligament or cartilage damage is evident.
anesthesia is typically used for this surgery, though
in some cases a spinal or epidural anesthetic is used.
The anesthesiologist will administer the anesthesia
once you are in the operating room.
arthroscope is inserted into the knee through a small
incision. Fluid is injected into the knee joint through
the same incision, which allows the surgeon to view
the knee joint and check to see if there are any cartilage
tears or ligament damage.
the MCL 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
screw or bone staple.
the tear occurred in the middle of the ligament, the
surgeon will repair the ligament by sewing the torn
ends together with sutures.
are sewn up and the patient is taken to the recovery
Following surgical repair of your MCL (medial collateral
ligament), 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. Your knee will be bandaged and may
have ice on it. 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. 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
Some patients remain in the hospital after surgery
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 MCL (medial
collateral ligament), you will need to take steps to
reduce the pain and inflammation in the knee. Rest,
icing, elevation, pain relievers such as aspirin or
ibuprofen can ease pain and swelling, and immobilizing
the knee will keep it stabilized. To immobilize the
knee, your physician may recommend that you wear a lightweight
cast or brace that will allow your knee to move backward
and forward but restricts side-to-side movement. Immobilization
usually is recommended for 72 hours. The cast or brace
may be designed so that you cannot bend your knee. If
this is the case, you will need to modify your behavior
so that you can 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 joint. 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
should be able to begin exercises to restore strength
and normal range of motion to your knee about four to
six weeks after surgical repair of your MCL (medial
collateral ligament). Once an MCL has fully healed,
you should have a minimum of long-term effects. Your
physician and physical therapist can help design a custom
rehab program that will start slowly with stretching
and build to strengthening exercises. 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.
If you are still experiencing soreness while you are
doing exercises, you should proceed slowly 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, and
physical therapy tends to become activity-oriented as
you regain the ability to perform complicated movements.
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.