Fibular Collateral Ligament FCL (Sometimes known as the Lateral Collateral Ligament LCL)
FCL tears are rarely in isolation. They occur alongside other knee ligament injuries when there is a significant hit to the knee. Pain and instability are the most common problems with an FCL injury. Because one of the large nerves of the leg runs right near this structure, numbness, burning, weakness can also occur. The most common injured structures when the FCL is torn is the remainder of the posterior-lateral corner (popliteus, popliteal fibular ligament, etc.), ACL tears, PCL tears, and hamstring tendon tears. Occasionally the fibular head is fractured off in this injury.
Non Operative Treatment of the FCL
The FCL can be treated non operatively with strengthening and rehabilitation and occasionally injections when the FCL injury is minor (grade I) and the knee is still stable. Specialized stress X-Rays can determine the degree of the injury and stability can be assessed on exam. The mainstay of FCL non-operative treatment is strengthening of the muscles around the knee, especially the hamstrings and bracing to protect the ligament. Focused physical therapy supervised by Dr. Petre is a great way to accomplish this.
Fibular collateral ligament surgery is a complex surgery that requires expertise in the field of sports medicine. Many factors should be considered when discussing surgery including the athletes level of competition, age, previous knee injury, other injuries sustained, leg alignment, and graft choice. Commonly the ligament needs to be replaced by a graft, either your own tissue or from a cadaver. This is done with incisions over the ligament and placing new tissue through tunnels drilled in the bone to replace the torn tissue.
Rehabilitation is crucial to any FCL surgery. Your FCL surgery will take 9 to 12 months for complete recovery and return to sports. Revision FCL surgery will often take 12 months to more than a year. During this time, Dr Petre will guide you through the rehabilitation process. The early rehab, usually lasting 6 weeks, will focus on maintaining full knee motion and preventing scar tissue. The second phase of rehab will then be directed towards regaining your strength. Finally, Dr. Petre will return the athlete sport specific rehab before returning the athlete to competition.
If Dr Petre recommends surgery for your FCL, he may prescribe rehab before surgery as many studies have shown that having good motion before your surgery will benefit you after surgery.
- How long does surgery take? 2-3 Hours
- What kind of anesthesia will I need? Dr . Petre recommends general anesthesia with or without a femoral nerve block for post operative pain control
- How long will I be in the hospital? Many patients can leave that same day, occasionally Dr. Petre will have you stay one night in the hospital
- Is surgery safe? All surgery has risks; however, FCL surgery when compared to all other surgery is very safe.
- Will I need physical therapy? Yes. Physical therapy is crucial to an excellent outcome.
- How long before I can return to work/school? For jobs and academics that require minimal physical exertion and can be done with crutches, many people can return in a few days to 2 weeks. For jobs that require heavy lifting or exertion, it is safe to plan 6 weeks off.
- How long before I can return to my sports? 9 months is a minimum to allow the graft to heal and 12 months is the average.
- How long before i can drive a car? All patients must be off pain medicine before driving. Many patients can return to driving in 2 weeks or less.
- How long will I be on crutches? A minimum of 2 weeks but this can be longer depending on the other injured structures. It is safe to plan for 6 weeks.
- How long will I need pain medicine? Most patients need 3-5 days of pain medicine and sometimes up to 2 weeks. If you are still having pain requiring narcotic pain medicine after a month, Dr. Petre may ask you to see a pain specialist.
- How long will I need a brace or sling? Typically, a brace is worn for the first 6 weeks. A sports ACL brace will be worn in sports for a full 1-2 years after surgery.