Category Archives: Knee

How to Deal with Emotional Issues During Orthopedic Treatment

By  aenriquez  published  September 29, 2018

Feeling a bit under the weather, during times of physical impairment?  Have you ever wondered if these midday blues will ever go away?  You might be asking yourself, what is the problem with me?  This is all normal during times of physical pain and treatment.

You just had surgery or are going to have a surgical procedure and you feel anxious.  You are nervous if the surgery will be successful or if you will ever feel the same again.  Will you be able to bend the same, walk normally, eliminate the pain and recover in a timely manner?  You have a right to ponder these unanswered questions.

Sometimes people don’t need advice or neurofeedback or a psychological evaluation.  What people need is family and friends to support them through difficulties and to listen while you vent.  It is very helpful to have people you care about understand your valid concerns.

When you face physical challenges and you must undergo a surgical procedure, it can bring about an onset of feeling anxious and potential depressive states.

What can I do about my emotional issues pre and post-surgery? 

It is extremely difficult to relax, but this one is a big solution to your bouts of anxiousness.  The old saying of mind over matter is powerful for the results that follow.  Lay down in a serene environment and visualize something happy.  When our thoughts are eased, our emotions remain calm as well.

It is also very beneficial to exercise self-care.  For example, take a hot bath (if you can), listen to soothing music, watch a Netflix series, read a book, meditate, pray, call a trusted friend, and write in a journal.

It is beyond frustrating when you are physically unable to walk, exercise or take a regular shower.  People internalize their aggravation and lack the coping skills to stabilize their moods and anxiety.

Part of the healing process prior to and after surgery is lovingly taking care of your mind, emotions and feelings, so you do not experience nerve-racking, uncontrollable episodes.  What we think about, we bring about.  We must learn to feed our mind positive words of affirmation and not negative ones, or we will become mentally exhausted.

The last resort would be to put a patient on a low dose of anti-depressant medication if they cannot learn to manage their emotions and become too stressed out.  Having a surgical procedure is very stressful as well and learning to deal with the pain it brings.  It is not easy to find the proper social support that is needed during fearful times. Worry takes over our once sound mind and produces negative side effects such as headaches, stomachaches, low sex drive, acne, decreased immune functioning and even suicidal thoughts.

Our biggest recommendation is to ASK for help and allow others to be there for you and let trained experts provide treatment, that will solve your issues.

FXRX employs the best medical staff to alleviate pain, but we are also here to assist in making sure you are mentally tranquil as well.  If you have questions, please email us or request an appointment https://www.fxrxinc.com/blog.html.

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Who is at Risk for Injuries and what Treatment Options Should I Choose

By  aenriquez  published  September 20, 2018

Accidents happen all the time and people get injured for numerous reasons!  Athletes fall while running, sports stars twist ankles or bash their knees in, the elderly tumble while shuffling in the driveway, kids fall off their bikes and crack an elbow, weapon mishaps occur to anyone not being careful, car accidents demolish organs on impact and freakish wounds are unstoppable.

Injuries are known as physical trauma. Injuries occur when outside forces cause damage to the body, in unexpected, harmful ways.  Injuries can be life-threatening and be the foundation for much-added pain throughout your body.

Who is at risk for injuries and why?

Anyone that plays a sport has an increased risk for potential injuries to any part of their body.  We know that accidents can occur to anyone, anywhere.  Therefore, athletic gear is enforced.  Kids are forced to wear helmets, cups, body armor, elbow and knee pads, as well as chest protectors.

The elderly are specifically at risk of breaking bones, fractures weaken bone areas or sprained wrists due to not having the same agile mobility as they had in their younger years.  Also, osteoporosis is more likely to occur in older adults.  Osteoporosis is defined as a medical condition where your bones are brittle, they become weak due to your body not making new bones fast enough, and this makes people easily prone to fractures.

Everyone is at risk for bodily harm in an unforeseeable accident with a firearm or automobile catastrophe.  You can lower your risks by not drinking and driving, going the speed limit, wearing your seatbelt, not texting and driving, paying attention to the road and do not get distracted from other people in the car.

At FXRS Orthopedics & Bracing, we have a variety of treatment options, depending upon the severity of your injury and pain level.

We offer various knee therapy choices:

Knee Arthroscopy (Knee Scope)

Knee Replacement

Cartilage Regeneration is done through a knee scope – to avoid a knee replacement

Steroid Injections in joints ease and reduce pain

Regenerative Medicine with PRP (Platelet Rich Plasma) Therapy (regenerate damaged tissue)

Orthopedic Bracing (used for arthritis, Carpal Tunnel, and fracture stabilization)

Shoulder Therapy Choices:

Rotator Cuff Repair

Shoulder Arthroscopy – known as a shoulder scope

Partial and Total Shoulder Replacement

Arthroscopic Shoulder Labral Repair

Arthroscopic Shoulder Instability Repair

We also offer fracture treatment and bracing for of these types of injuries.

Our trained surgeons will devise a medical plan that is best for your personal situation.  You are not just a number in our practice.  Our doctors listen to your concerns and care about your road to recovery.

If you would like to schedule an appointment – sign up here https://www.fxrxinc.com/.

We will be with you every step of the way, no matter what solution your body needs.  We want you to live pain-free!  If you have questions or concerns – email us at https://www.fxrxinc.com/contact.html.

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Comminuted Fractured Treatment – How is it Beneficial to Patients?

By  aenriquez  published  September 13, 2018

Are you clumsy?  Do you easily fall or break bones? Getting older and your bones seem to be brittle?  Middle of the night, hospital visits are your norm?  Typically, we would relate this to the elderly or those with brittle bone (osteoporosis), but it can happen to anyone.

I can honestly say, I have never fractured anything or had to seek long-term treatment for bothersome ailments.  Tons of Americans want quick fixes and to feel pain-free immediately.  I prefer the proper care and treatment for safer longevity and stability.

Every bone in our body has the potential to be broken, fractured or dislocated.  There is a treatment that trained doctor’s use and you must do so very carefully and wisely.

Comminuted Fracture Treatment is much more complicated than normal fracture breaks because bones are severed in three or more fragments.  Communized fractures are put under a lot of pressure and eventually end up being severed in several places.  Surgery is usually imminent.  Risks could impose major complications and treatment tends to be tricky.  Surgeons need to rehabilitate every broken piece of bone and will use screws or specially made cement to fuse pieces together.  If the bones do not require a surgical procedure – readjustment might be possible.

Comminuted Fracture Home Solutions:

Get proper rest and try to keep the pained area stable, elevated and free of movement until it is healed. Your goal should be to regain strength and get back to normal.

Prescribed Pain Medication will be needed in some cases as deemed necessary, but not expected.  Often pain is unbearable, and a script is needed for soreness, throbbing sensations, and agony (at times). Caution getting addicted to pain medications, overusing them, and having to up your dose for pain relief.

Why do Comminuted Fractures occur?

Accidents cause most of the fractures that specialists see.  There must be a great amount of pressure such as experiencing a massive car crash or gunshot wound.

Individuals with Osteoporosis (weak bones) or cancer can fracture body parts easily in several various places. As adults get older, bones deteriorate and the decline in strength makes a quick fall traumatic.

Athletes occur in people who play more than one sport (typically) as this increases their risk of injury.

FXRX https://www.fxrxinc.com/ employ’s topnotch orthopedic surgeons that are highly trained for all extremities including:

◻Hip, Femur, Knee and Let Fractures

◻Hip Fractures, Distal Femur (Thighbone) Fractures of the knee

◻Femur Shaft Fractures (Broken Thighbone)

◻Fractures of the Proximal Tibia

◻Foot and Ankle Fractures

◻Upper Extremity Fractures

Therapy and treatment guides us through significant changes that eventually improves our lives in new miraculous ways.  I believe our staff to be the best in the industry and work tirelessly to put you back together, one piece at a time!

“Change, like healing, takes time.”  — Veronica Roth, Allegiant

 

 

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Knee Treatment – You Have Many Options to Heal

By  aenriquez  published  September 5, 2018

Living with pain is not an option many are willing to tolerate, especially when life becomes unbearable and debilitating.

There are many treatment options that are available to our patients, highly effective and will get you on the road to recovery, quickly.

Knee pain is very common and treatable.  It is easy to diagnose why you have pain, but it takes a skilled physician to determine which treatments are best for healing.

Knee injuries occur in people who are athletic, play sports, have degenerative arthritis, osteoporosis, or a shocking life event (like a car accident).

Knee Arthroscopy (Knee Scope): Minimally invasive surgical procedure, where a highly trained surgeon will shave soft tissue or repair and reconstruct ligaments and cartilage.

Meniscectomy: most commonly used with a knee scope, where torn cartilage in the knee is shaved to alleviate knee pain.

Partial and Total Knee Replacement: one of the most successful orthopedic surgical procedures in treating your damaged knee, due to post-traumatic arthritis or inflammation.  Partial knee replacement is beneficial to those patients who need only one part of the injured knee replaced.

Cartilage Regeneration: cushions the knee to allow for painless mobility. 

Articular Chondrocyte Implantation: biopsy is taken to evaluate the cartilage in the knee, arthroscopic surgery is then performed to implant cartilage into the defect to heal.

Osteo Transfer Surgery: cartilage from a healthy area is taken and is moved to the damaged area in the knee.

Microfracture Procedure: an arthroscopy procedure used to stimulate new cartilage growth.  If you cannot actively participate in sporting events, athletics (such as weight lifting or running) due to pain, then we recommend giving this treatment a try.  We warn all patients that this procedure may not last long term.

DeNovo Natural Tissue Graft: used in the specific treatment of articular cartilage defect.  This is one of our newest methods of rejuvenation and healing, where a donor’s juvenile cartilage is used.  An outpatient procedure where donor tissue gets inserted into the defected area and molded with fibrin glue.

 

Orthopedic Bracing (Orthosis): is a medical device, with various functionalities.  Sometimes it is used to reshape the body or hinder any mobility of a specified part of the body.  The orthopedic brace is also used to take the weight off the injured area. 

Steroid Injections: injecting medication into your knee will remove negative symptoms.  The drugs work through your joints ( pained area) and work immediately.  Inflammation tends to decrease within 24-48 hours but used for short-term relief only.

At FXRX https://www.fxrxinc.com/kneesurgery.html

We offer the utmost quality care, with trusted experts, who want to see you 100% healed and healthy.

We will find where the pain is located and take actionable steps in correcting it.  Let us help you find the right treatment solution, for your specific injury.

“The natural healing force in each of us is the greatest force in getting well.”  — Hippocrates

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When A Full Knee Replacement is the Only Option

By  aenriquez  published  May 24, 2018

No-one wants to undergo a knee replacement operation but, if you are experiencing a huge amount of pain and movement is drastically reduced, surgery may be the only option. There are various reasons as to why you may need one, arthritis could damage the cartilage so that it has worn thin and bones grating against each other has made any movement painful. When you have the knee replaced, the remaining cartilage is often replaced by both plastic and metal parts. These parts interlock so that your knee can bend. Of course, having arthritis does not mean that surgery is essential. There are always other options to consider first such as stem cell therapy.

full knee surgery

There may be times, however, when stem cell treatments are just not suitable and of course, your medical professionals will guide you through the list of options. Certainly, knee surgery has changed dramatically over the last few years, with many advances being made and although this is offered less, there are times when there are no other options.

A partial knee replacement sounds less invasive than the full version but in truth, a partial knee replacement needs to have some very precise surgery i.e. bone being shaved back. This is a critical procedure as alignment must be perfect. If too little bone is removed, this would be as bad as removing too much. A partial knee replacement enables a quicker recovery rate, but it is not always possible.

 

The advantages of full knee surgery:

  • Increased mobility
  • Decreased pain

If you are suffering from knee pain and have been advised that surgery may be required, you may be understandably nervous. There are many benefits to having surgery but, there are always some risks. Risks are typically associated with age, although there are no actual age restrictions, however, most surgery of this type occurs between the ages of 50 to 80 years of age. Your health is a big consideration. If you are suffering from heart problems or, have a chronic health condition, surgery may not be an option.  Infections and blood clots can arise but, this is extremely rare. The benefits far outweigh the risks.

 

It is good to consider why you want treatment:

 

  • You are in severe pain
  • The knee joint is so stiff
  • Even when resting, pain is intense
  • You struggle to bend the knee joint
  • Chronic swelling does not dissipate
  • Another treatment has failed

 

A complete knee replacement today is much more efficient than ever and, also, less invasive.  Recovery time is quicker, and the success rate is very high. Once the surgery is over, there is less time spent in the hospital and you will be able to go home and really start the recovery process. To live without severe pain or stiffness is life changing. You can exercise, you can move, and you can sit in comfort. Importantly, you can get life back on track, hopefully, meeting friends and family regularly and avoiding low or fluctuating mood caused by pain and isolation.

 

If you are considering having a full knee replacement you are certainly not on your own. Many famous names are on the list and in the case of Steve Tyler from the rock band Aerosmith, it is hard to imagine that he had surgery as his movement is as good as ever.

 

Need to find out more information about your options for surgery? At the FRFX website, you can arrange an appointment with a medical professional. There really is no need to be in severe pain in modern times. Help is at hand.

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Physical Therapy and Rehabilitation

By  aenriquez  published  May 18, 2018

Physical therapy involves the use of certain maneuvers and exercises to restore your strength, activity, and motion following an injury, illness, or surgery. Physical therapists are trained professionals who identify deficiencies in the biomechanics of the body, they and teach stretches and techniques to address problems that can be managed. Physical therapists also use specialized equipment to address your condition and injury.

dealing with pain with Physical Therapy

Stretching Tight Joints and Muscles

A portion of physical therapy deals with stretching muscles and joints. Stretching is vital in maintaining good range of motion with the joints and for flexibility of muscles. If you suffer from tight muscles and/or stiff joints, normal activities can be affected. This includes climbing stairs, reaching overhead for items, and going through usual daily living. With proper stretching, these functions are preserved. After surgery, scar tissue forms and soft tissue will contract. To ensure that scar formation does not affect rehabilitation, it is important to go through regular stretching routines.

Strengthening the Body with Exercises

Exercises are used for strengthening, which helps with rehabilitation to improve muscle function and joint stability. The goal of improving strength aids in improved range of motion and increased endurance. Post-operative exercises should be guided by the physical therapist to ensure you do not injure the surgical area. These exercises are used in back, neck, knee, and shoulder injuries.

Core Strengthening and Stability

One of the most recent physical therapy developments involve the emphasis on core stability and strengthening. The core of the body should be solid and strong. A weak core puts you at risk for injury and chronic overuse syndromes. Core strengthening emphasizes the muscles of the pelvis and back. Some exercises programs are great for core stability, especially Pilates.

Application of Ice and Heat

Ice and heat are used for cooling down and warming up joints and muscles. Warmth also increases blood flow to the injured or healing region, and ice will decrease swelling through vasoconstriction. These mechanisms are very important for the therapeutic process.

Ultrasound

Using high-frequency sound waves, ultrasound therapy is used to stimulate the deep tissues in the body. The ultrasound probe is passed over your body, and deep tissues are stimulated by the vibration of a sound wave. Ultrasound will lead to warming and increased blood flow to the afflicted body tissues.

Electrical Stimulation

Electrical stimulation is a type of therapy used to pass electric current over an affected area. Nerve condition within a region can be altered which affects muscle contractility. Blood flow to the deep tissues is increased through electrical stimulation, and patients experience diminished pain after this treatment.

Reasons for Physical Therapy

The main reasons you should have physical therapy include:

To promote healing – This is used to minimized scar tissue of the knee or shoulder following surgery, and to improve blood flow to the injured area.

To regain mobility – Physical therapy is particularly important for the knees, hips, and upper extremities. It will help prevent joint stiffening and get you moving quicker.

To enjoy a faster recovery – Rehabilitation is used to help your body recover more quickly that if you do not receive physical therapy.

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Benefits of Orthopedic Bracing

By  aenriquez  published  March 22, 2018

Braces and splints are useful for chronic and acute conditions alike. They can also be used for prevention of injury. There is much scientific evidence that supports the use of braces and splints.

Unloader Knee Brace

The unloader (valgus) knee brace is often used for pain reduction in people with osteoarthritis of the medial compartment of the knee. These braces are designed to apply an outside (external) force to reduce the load on the medial (central) knee compartment, which reduces pain. Improved joint proprioception also helps to relieve pain. In a study involving 120 patients with knee osteoarthritis and varus deformity, researchers found that the unloader knee brace helped relieve pain and improve functional status. The benefits of this brace were found to be greater than a hinged brace.

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Common Knee Injuries

By  aenriquez  published  March 2, 2018

Knee Injuries

Many people enjoy playing sports and participating in physical activity, whether playing for fun in the backyard or competitively on a sports tea. Sports participation is beneficial to your health, but there is always the risk of injury. The knee is very vulnerable to injury in sports and everyday life. Knee injuries can occur due to poor training practices, flawed techniques, improper equipment, or accidents.

The knee is a complex joint that serves as an integral component of healthy mobility, and when one experiences an injury, he or she often requires surgery and physical therapy. Our orthopedic specialists are skilled at diagnosing and treating these common knee injuries. We assess your knee, conduct testing and imaging to confirm the problem, and develop a comprehensive treatment plan.

Sprains and Strains

The most common types of knee injuries are sprains and strains. A sprain occurs when a ligament tears or stretches beyond normal points. A ligament is a band of connective tissue that attaches bone to bone, and sprains range from minor ligament tearing to severe severing. A strain is where a muscle or tendon stretch beyond normal, and this can also be minor or severe.

Shin Splint

A shin splint is pain along the tibia (shin bone). This pain is typically at the anterior (front) region of the lower leg, but it can also occur in the knee region. Shin splints often affect runners who run on hard surfaces. Contributing factors for shin splints are poor running shoes, lack of support, failing to warm up/stretch, and having flat feet.

Fractures

The knee bones include the femur, tibia, and patella. Small cracks in any of these bones can occur from repeated stress. A stress fracture occurs from repeated impact, such as jumping or running. A patella fracture can occur from a fall onto the kneecap region. A tibia plateau fracture occurs when sudden excessive pressure collapses the top region of the tibia bone.

Dislocations

A dislocation occurs when one bone of a joint comes out of alignment. Also known as luxation, excessive stretching, falling, and twisting injuries can lead to a dislocation. Dislocated bones may be able to be realigned by a doctor, but some of these injuries require surgery. The condition involves bones of the knee being dislodged partially or completely.

Anterior Cruciate Ligament Injury

The anterior cruciate ligament (ACL) is an important knee structure. Injuries of the ACL are not just problems for athletes. A partial or complete ACL tear can occur from a quick change of direction, or from a compressive pressure of landing improperly when jumping. Damage to the ACL can cause an unstable knee.

Posterior Cruciate Ligament Injury

Posterior cruciate ligament (PCL) injury occurs when the knee is in the bent position. This type of injury results usually in only a partial tear and injury of the PCL can occur from falls or car accidents. The PCL does not have good blood flow, so tears of this type have difficulty healing.

Meniscus Tears

The meniscus is a wedge-shaped cartilage that serves as a cushion between the femur and tibia bones of the knee joint. Twisting or squatting can result in a meniscus tear, which also occurs from normal degeneration as people age.

Patellofemoral Syndrome

When the underside of the patella becomes irritated and inflamed, patellofemoral syndrome occurs. This is related to the kneecap rubbing against the femoral condyle with extension and flexion (bending) of the knee. The inflammation can result in serious pain.

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Can You 3D Print Knee Cartilage?

By  aenriquez  published  January 8, 2018

Young or old, you’ve probably felt a nagging pain in your knee at some point.  In fact, some studies suggest that knee pain has increased up to 65% in the over the past few decades. But for some that pain becomes constant and unbearable. That can be for a number of reasons including:

Printing 3D Cartilage for Knee Surgeries

  • Osteoarthritis (often referred to as degenerative or “wear and tear” arthritis
  • Damage to the meniscus or cartilage (this can also be caused by osteoarthritis)
  • Gout
  • Tendonitis
  • Bursitis
  • Torn ligament or tendon

 

For many of these conditions, there are clear treatment plans that pave a way to recovery. However, cartilage damage (the regions of cartilage in the knee are known as menisci) has previously been tricky to treat. But now revolutionary technologies and surgeries could provide hope to those suffering in silence.

 

What do the menisci do?

 

The menisci sit on the bones of your knee and act as cushions. They absorb shocks and make sure the bones of your knee don’t bump and rub against each other. However, unlike most tissues they don’t have a blood supply and as such can’t get the nutrients they need to repair themselves. Damage often occurs in young people with sports injuries. You may hear doctors talk of the “unhappy triad” where athletes tear their ACL, MCL and damage their medial meniscus. This is what happened to Judy Hobson who talked to the DailyMail about her road to recovery

 

“I had to give up sport altogether. I could barely walk a couple of hundred yards and was starting to limp. I was miserable because it was such a huge part of my life. I even thought about having my leg amputated and being fitted with an artificial limb”

 

A 3D printing breakthrough

 

New hope could be on the horizon as researchers at the University of Alberta are working on 3D printing knee cartilage needed for transplant surgery. They have been able to print a 3D leaf made of natural proteins. One of the engineers, Stella Matthews, said

 

“It is the first step towards tissue engineering,”

 

Next, they will try to print cartilage shaped for the individual that surgeons can transplant into the patient’s knee.

 

What can be done at the moment?

 

Whilst these results are highly exciting, they aren’t available for the patient right now. However, patients can still have a meniscus replacement surgery. This is what Judy Hobson had done. Again talking to the Daily Mail she said

 

“After nine months, I could walk more than a mile pain-free – now it’s five or six miles and I’ve also started to play a little volleyball again. I’m so grateful to the person who donated the meniscus.”

 

Specialist clinics across the United States offer the procedure. Ricky Valadez, who had the procedure and talked to Fox32 about it said

 

“The best thing, in the long run, is I’m going to be able to have the opportunity to do whatever I want and not be held back,”.

 

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What are Lateral Collateral Ligament Injury Symptoms that need Surgery?

By  aenriquez  published  December 27, 2017

Knee Ligament InjuryLateral collateral ligament (LCL) injury often requires reconstructive surgery. LCL reconstruction is necessary to avoid rotational instability of the knee and cartilage damage. The extent of damage can affect the outcome of surgery. Certain symptoms exist that make surgery necessary. Our orthopedic surgeons are able to reattach the ligament with sutures or reconstruct it using donor tissue.

The lateral collateral ligament is one of the four major ligaments of the knee. The LCL is outside of the knee, and it connects the femur (thigh bone) to the fibula (lower leg bone). The LCL’s main function is to avoid varus stress across the knee (buckling outward). Together with the popliteofibular ligament, the joint capsule, and the popliteus tendon, these structures form the PLC complex, which gives you external rotational stability.

 

LCL Injury and Symptoms

Lateral collateral ligament injury symptoms vary from person-to-person. Injuries to the LCL and posterior lateral corner occur from a rotational force across the knee. A contact injury is a direct blow to the inside of the knee, whereas a non-contact injury is caused from hyperextension stress. The symptoms of LCL injury include:

  • Swelling and tenderness along the outside of the knee
  • Pain that can be mild to moderate
  • Feeling that the knee will give way under stress
  • Numbness or weakness of the foot related to the peroneal nerve, which is near the ligament stretched during injury

 

Can you Walk with a Torn LCL?

A torn lateral collateral ligament can produce severe pain and limit movement, depending on the severity of the injury. However, some people can walk following an injury or tear to the LCL. The doctor will grade the tear based on symptoms. A careful eye is needed to diagnose a posterolateral and lateral injury. The doctor will check for:

  • Ecchymosis and skin abrasions on the side of injury
  • Pain on palpation
  • Difficulty ambulating
  • Loss of normal knee movement

Diagnosis and grading of the tear are confirmed using a magnetic resonance imaging (MRI) scan. An MRI has a 90% accuracy for showing tears of the posterolateral corner and ligaments. To isolate the LCL, the doctor will apply stress during flexion and compare the knee to the other one. Signs that the knee requires surgery include a positive prone “dial” sign, problems with foot eversion and inversion, and severe tearing found during arthroscopy.

LCL Surgery for Tears and Injury

The lateral collateral ligament does not heal as well as the medial collateral ligament. For a minor tear, non-surgical treatment is used (bracing, rest, and ice). For high-grade acute tears, the ligament must be surgically reattached to the femur or fibula, depending on the situation. Surgical management includes open reconstruction using an allograft (donor material) or autograft (from the patient). The mini-open surgery involves a tiny incision and use of special tools and a camera to repair the ligament. The ends can be sewed together in certain cases where the ligament is torn into two pieces.

For a ruptured ligament, the surgeon will evaluate the situ1ation and make a surgical plan. Be sure to discuss all options with the orthopedic specialist and inquire about alternative therapies. When surgery is required, expect to have 4-12 weeks of recovery, which involves working with a physical therapist to regain strength and function of the knee.

Resources
King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees. Arthroscopy. 2016 Sep;32(9):1814-9. 
Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci. 2016 Nov 19. pii: S0949-2658(16)30217-2. doi: 10.1016/j.jos.2016.10.009.
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