What is Medial Collateral Ligament Repair

Medial collateral ligament (MCL) is a band of tissue in the knee. It connects the top of the shin bone (tibia) to the bottom of the thigh bone (femur). The MCL helps to hold the knee joint in place. If the MCL tears or gets torn away completely (avulsed) from its attachment to a bone, surgery will need to be done to repair it. Surgery may involve one of the following:

• Stitching the MCL back together.
• Reattaching the MCL to the bone.
• Removing the torn MCL and using other tissue (a graft) to replace the MCL. The graft may be held in place with sutures, staples, or screws. The graft is usually a band of tissue that connects muscle to bone (tendon). The tendon graft may be taken from:
  • Somewhere else in your body, usually near your knee (autograft).
  • A donor (allograft).

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to blood vessels, nerves, or other tissues in the knee.
• Failure to heal properly. This can result in an unstable knee.
• Stiffness.
• A blood clot that forms in the leg and travels to the lung (pulmonary embolism).

What happens before the procedure?

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for one month or more before your surgery. If you need help quitting, ask your health care provider.
• Do not drink alcohol unless your health care provider says that you can.
  • If your health care provider says that you can drink alcohol, limit how much you have. This means 0–1 drink a day for women or 0–2 drinks a day for men.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider what steps will be taken to help prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the knee area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
• Several incisions will be made on the inner side of your knee. The size and number of incisions will depend on your injury.
• A thin tube that has a light and camera on the end of it (arthroscope) will be passed through one of the incisions and into your knee joint. The camera will send images to a screen in the operating room. These images will be used to assess the extent of your knee damage.
• Other surgical instruments will be passed through the other incisions, and your MCL will be repaired as needed.
• Your incisions will be closed with sutures or staples and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You will be given pain medicine as needed.
• You may be given medicine to lower your risk of blood clots.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• Your knee may be placed in a brace that allows you to bend your knee (hinged knee brace).
• You may be shown how to do physical therapy exercises to help you recover.
• Do not use your knee to support (bear) any of your body weight. Follow weight-bearing restrictions as told. You may be given crutches or a walker to help you walk.
• Do not drive until your health care provider approves.

Summary

• The medial collateral ligament (MCL) is a band of tissue that helps to hold the knee in place.
• MCL repair may involve stitching the MCL together, reattaching it to bone, or replacing it with other tissue (a graft).
• You will not be able to use your knee to support (bear)any of your body weight or drive until your health care provider approves.

Medial Collateral Ligament Repair, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain that can be relieved by taking pain medicine.
• Bruising, swelling, soreness, and stiffness.

Follow these instructions at home:

If you have a brace:

• Wear the brace as told by your health care provider. Remove it only as told by your health care provider.
• If you cannot remove the brace for bathing, and the brace is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or shower.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Keep the brace clean.

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), staples, skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness.
  • More swelling or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Activity

• Do not use your knee to support (bear) your body weight until your health care provider says that you can. Follow weight-bearing restrictions as told. Use crutches or a walker as told by your health care provider.
• Ask your health care provider what activities are safe for you during recovery, and ask what activities you need to avoid.
• If physical therapy was prescribed, do exercises as directed. Doing exercises may help to improve knee movement and flexibility (range of motion).
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Driving

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Managing pain, stiffness, and swelling

• If directed, put ice on your knee area.
  • If you have a removable brace, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your brace and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your knee above the level of your heart while you are sitting or lying down. To do this, try putting a few pillows under your knee and lower leg.

If you are taking blood thinners:

• Before you take any medicines that contain aspirin or NSAIDs, talk with your health care provider. These medicines increase your risk for dangerous bleeding.
• Take your medicine exactly as told, at the same time every day.
• Avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.
• Wear a medical alert bracelet or carry a card that lists what medicines you take.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
  • Take an over-the-counter or prescription medicine for constipation.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay incision or bone healing. If you need help quitting, ask your health care provider.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have a fever.
• Notice that an incision feels warm to the touch.
• Have redness around an incision.
• Have more swelling or more pain around an incision.
• Have more fluid or blood coming from an incision.
• Notice pus or a bad smell coming from an incision.
• Have pain that does not get better with medicine.

Get help right away if you:

• Notice that an incision opens.
• Have numbness or tingling in your lower leg or your foot.
• Develop warmth, tenderness, or swelling in your lower leg or at the back of your knee.
• Have chest pain.
• Have trouble breathing.

Summary

• Pain, bruising, swelling, and stiffness are common after this procedure.
• If your brace is not waterproof, do not let it get wet.
• Contact your health care provider if you have pus or a bad smell coming from an incision.
• Make sure you know what symptoms should cause you to get help right away.