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.
RELATED TOPICS
What
to ask the doctor
What
to take to the hospital
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.
RELATED TOPICS
ABC’s
of anesthesia
What
to take to the hospital
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.
RELATED TOPICS
Recovery-proof
your home
When
to call the doctor after surgery
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.
RELATED TOPICS
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.
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