Knee > LCL Tear > Treatments

   Lateral Knee Reconstruction

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.

   Make 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 is scheduled.

   Understand 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.

   Any 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.

   Discontinue the use of any anti-inflammatory medicine a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   To reduce the risk of infection and other complications during open surgery, try to refrain from cigarette smoking for at least a week leading up to surgery.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make 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.

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If your LCL has been severely damaged and cannot be repaired, a reconstruction using a tendon graft from your thigh muscle (quadriceps) or hamstring will be used. Lateral knee reconstruction is an open-knee procedure, and is not performed arthroscopically.

   General anesthesia is typically used for this type of 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.

   An incision is made on the outside (little-toe side) of the knee. Other incisions are made to allow the surgeon to remove the tendon that he will graft onto your LCL.

   The tendon graft is passed through bone tunnels and fixed to the thighbone (femur) and lower leg bone (fibula) using screws or posts, or with sutures tied around a post.

   Incisions are usually closed with stitches and the patient is taken to the recovery room.

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If your LCL has been severely damaged and cannot be repaired, a reconstruction using a tendon graft from your thigh muscle (quadriceps) or hamstring will be used. Lateral knee reconstruction is an open-knee procedure, and is not performed arthroscopically.

   General anesthesia is typically used for this type of 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.

   An incision is made on the outside (little-toe side) of the knee. Other incisions are made to allow the surgeon to remove the tendon that he will graft onto your LCL.

   The tendon graft is passed through bone tunnels and fixed to the thighbone (femur) and lower leg bone (fibula) using screws or posts, or with sutures tied around a post.

   Incisions are usually closed with stitches and the patient is taken to the recovery room

After lateral knee reconstruction, 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.

After lateral knee reconstruction, 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. Often, bracing or casting is required. Ice also helps control pain and swelling.

After lateral reconstruction, 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 that 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 knee 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.

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You should be able to begin exercises to restore strength and normal range of motion to your knee about four to six weeks after lateral knee reconstruction surgery. Once a reconstructed LCL (lateral collateral ligament) has fully healed, you should have a minimum of long-term effects. 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.

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   Knee 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:

   Manage 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.

   The 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.

   Stretching 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-cushioned, well-fitting athletic shoes can reduce the impact of the load exerted on the knee.

   If 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.