Injuries and Conditions: Lateral Collateral Ligament Injury : Lateral Collateral Ligament Injury :
A damaged LCL will not necessarily require surgery for a full recovery. Differences in the severity of the injury will affect the treatment decision. LCL injuries range from minor sprains to complete tears of the ligament. Minor injuries can be treated non-surgically based on the symptoms present. Severe injuries including complete tears require early surgical intervention to achieve an optimal outcome.
A torn PCL is usually difficult to stitch together after injury because the torn ends are frayed and difficult to manage. Most often, the torn ligament is completely replaced with material from the patellar tendon, though the ligament can also be supplemented with synthetic material.
An arthroscope is inserted into the knee joint through a small incision in the skin. The arthroscope contains a tiny fiber optic camera and is used to project images onto a monitor which the doctor uses to view the inside of the knee.
Fluid is introduced to the knee through another incision to clear away any blood and to distend the joint. A third incision is made to allow working instruments, such as scissors or a knife, into the joint. As the doctor views the interior of the knee from the monitor, he is able to work the surgical instruments with one hand while placing the arthroscope with the other hand.
A complete physical examination which provides an assessment of the patient's overall health.
An examination of the range of motion and the degree of stability in both the injured and uninjured knee.
Strength and walking (gait) measurements and analysis.
Knee arthrometry is utilized to measure the tightness and stability of the knee.
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
Immediately following surgery, it is important that the knee obtains full extension. A continuous passive motion machine (CPM) may be used after surgery to help facilitate the movement of the knee, and the patient is given instructions on extension exercises for self-exercise at home.
At the first post-operative visit to the doctor, the sutures are removed, motion is examined, and the patient is directed to a physical therapist.
Braces are recommended until the patient has good control of the knee and can easily extend the leg and do deep knee bends without difficulty.
Close examination of the knee during the following 4-6 weeks is needed to ensure that the knee is correctly healing.
Patients should avoid putting a pillow under the knee. (This will tend to bend the knee and will prevent the full straightening of the joint)
More athletic activities like jogging are usually allowed after three months, though often only in a controlled environment as on a treadmill.
Sport-specific exercises are allowed according to their intensity level and strain on the recuperating knee.
Post Operative Instructions:
Wear the brace at all times, except when bathing or showering.
Bear weight as tolerated in the brace with the knee locked in full extension.
Use crutches as needed until stability returns.
Ice the knee three times a day for 20 minutes.
Keep the wound dry until the sutures are removed. If necessary, the dressing can be removed for showering (with the knee wrapped in plastic kitchen film) after 4 days.
Unlock the brace when using the continuous passive motion (CPM) machine doing exercises, or sitting.
Use the CPM machine for up to 8 hours daily. Start at 30 degrees. Progress in 5 degree as comfort allows. Discontinue using the CPM machine when the knee can bend to 90 degrees without using the machine.
Three times a day, for 30 minutes each time, sit with a large towel role under the heel with the brace locked in full extension.
It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following PCL surgery. If this becomes severe or the patients develops a fever, calf pain, shortness of breath, or chest pain, contact a doctor immediately.
A surgically reconstructed PCL which has been properly rehabilitated should allow the patient to eventually regain complete strength, stability, motion, and control of the knee.
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
Injury to the repaired PCL is possible if physical therapy or other activities during rehabilitation is overly strenuous, causing damage to the repaired ligament or tendon graft.
The patient may have decreased mobility of the knee, even after the patient has followed physical therapy routines.
The reconstructed PCL is often as strong as the original ligament, and will tend to remain robust if not subjected to abuse.
Physical therapy is designed to restore strength, stability and range of motion through exercises, stretching and muscle stimulation.
The initial goal of therapy is to re-establish a full range of motion in the knee.
Ongoing therapy rehabilitates the quadriceps and hamstrings, the surrounding muscles which add strength and control to the joint.
Partial or complete tears will require bracing to provide stability to the inner aspect of the knee while the ligament heals.
Patients with mild LCL injuries that are stable with inner knee stress testing are generally treated based on their symptoms, without the use of a brace. Rehabilitation focuses on regaining knee range of motion and quadricep/ hamstring strength.
Patients with moderate to severe instabity during knee stress testing are treated with a brace for 4-6 weeks. This brace is typically hinged to allow a range of motion from 0-90 degrees. Crutches are used until the patient can fully extend the knee and can walk normally without them.
Range of motion exercises are started early, initially in a pain free arc. Once range of motion is restored hamstring and quadricep strengthening is begun.
With severe injuries in patients involved in contact sports, such as football, a functional knee brace may be helpful to prevent re-injury when they return to sports.
| Knee: Compression SleevesKnee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.
Knee compression sleeves can be used to treat:
Light swelling.
Light knee strains.
Chronic inflammation.
Degenerative joint disease.
| | Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion
and provide compression to aid healing and reduce pain and swelling.
Patients suffering from knee strains or inflammation will usually be
directed to use a support during daily activities.
The thin and flexible construction of the support allows for normal
movement of the knee and also allows the support to be worn under
loose fitting clothing. To prevent harmful pressure to certain
structures, the support applies differing compression around the
knee. The sides of the joint receive intermittent pressure to help
stimulate blood flow while the rear of the support fits relatively
loose to prevent constriction of circulation. The kneecap is aided
in positioning, but remains free of compression to allow its natural
movement.
Knee supports can be used to treat:
Strains
Sprains
Inflammation
Chondromalacia patella
| | Knee BracesKnee braces are used to help control movement in an injured or rehabilitating knee. Patients that have suffered ligament injuries will usually be required to wear a brace during the different stages of recovery. If the injury requires surgery, then the patient may initially be required to wear a post-operative brace. This type of brace is designed to minimize motion during the early period after knee surgery or a knee injury. During this time, the knee is attempting to heal and undesired motion could be harmful.
Upon return to sports requiring contact or side-to-side motions, a functional or ligament knee brace may be prescribed to provide support and protect the injured/reconstructed knee. These braces can be purchased as "off-the-shelf" or "custom-fit" braces. The "off-the-shelf" brace can be sized appropriately, so that the fit will allow the knee to move freely and comfortably with the knee's own natural motion. Custom fit braces are also available for the more difficult to fit patients.
Knee braces can be used to treat:
Pre-operative ACL/PCL ruptures or injuries
Non-surgical ACL/PCL injuries
General knee instability
Pre/post joint replacement with ligament instability
Grade II or III ligament sprains.
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Patients with more minor injuries can expect to fully recover within 2-4 weeks, especially if physical therapy is undertaken.
Patients suffering severe injuries that have resulted in the partial tearing of the LCL will require much longer to rehabilitate, although a full recovery is still possible with intensive physical therapy. These injuries may heal over three or more months.
A patient who is considered fully recovered may participate in athletic activities at their pre-injury level.
Patients that have not achieved full recovery will need to reduce their level of physical intensity to prevent further injury to the knee. In some cases this will mean completely forgoing certain activities that place particular stress on the knee.
Recovery is more dependent on the condition of the joint before and after injury, and how the internal structures have been repaired, than on the number of days, weeks or months since the injury occurred.
Risks are minimal and complications are rare.
The most common major complication is re-injury of the LCL, especially in contact sports.
Residual laxity(looseness)may develop in patients with moderate to severe injuries that are not braced long enough for the ligament to heal properly. If the laxity limits activity and cannot be corrected with functional knee bracing, surgery may be necessary.
Stiffness can develop if patients are immobilized after the injury and if gentle range of motion is not started early.
This condition does not require surgical hardware.
A ligament augmentation of a chronic LCL tear is often needed when the ligament is dengenerated or irrepairable. A tendon graft from the healthy knee or a transplant tendon is often used. This tendon graft is attached with a staple and/or screw.
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