Knee > MCL Tear > Treatments

   Surgical Repair

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.

   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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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:

   You 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.

   Since 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.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take 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.

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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.

   General 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.

   The 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.

   If 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.

   If the tear occurred in the middle of the ligament, the surgeon will repair the ligament by sewing the torn ends together with sutures.

   Incisions are sewn up and the patient is taken to the recovery room.

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.

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.

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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 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.

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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.