Broken fibula,Lateral collateral ligament,ACL rupture

Hi, I am sorry to hear about your injury. Have you been recommended any surgery yet by your physician? I just recently learned that it is best to have surgery within 3 to 4 weeks after the injury because it is possible for the doctor to repair your ligaments. Unfortunately, I did not have this opportunity. I tore my ACL, PCL, AND MCL when I fell at work. Although, I was taken to the emergency room right away, the doctor did not begin to assess me until around a month after the injury. Even worse, I had my first operation almost 2 months after the injury. So, don't waste time because it is very important that you get the type of care you need.

Kingsly619,

Sorry about your injury. You do not state how old you are, at what level of competition you wish to return to playing (if you do want to continue to play sports), and what type of work you have to do (desk vs construction).

If you were to rank your injuries, they would probably go something like this:

1. Anterior cruciate ligament rupture, complete
2. Lateral collateral ligament injury, avulsion from fibular head, includes a small flake of bone (severity not given)
3. Biceps femoris muscle insertion, avulsion from the fibular head, includes a small flake of bone (severity not given)
4. Popliteal - There is an oblique popliteal ligament in the posterior aspect of the knee, but there is also a popliteus muscle which attaches to the same point as the LCL and biceps. So, it is a little confusing as to which structure is being listed here. But, both of these structures are secondary supports.


So, you have a pretty significant injury to your knee. You are lucky that you did not also tear one of your meniscal cartilages or damage the articular cartilage surfaces on the tibia and femur.


So, what do you want to be able to do later on down the road? Many years ago, the only patients who were offered surgery for an ACL injury were young (under 25), elite, highly competitive athletes. But, now, anyone who wants to continue participating is pivoting sports and is unable to get the knee strong enough to prevent twisting, is offered surgery.

So, just because you have an ACL injury, does not mean that you absolutely have to have surgery.


But, if you want to play competitive, pivoting sports, on a regular basis, or if your leg is so weak and balance so poor, that you fall on your face just about every time you slightly pivot,... then you should probably have the surgery.

The surgery is a lot easier on the patient now that all most all of them are done with arthroscopic assistance. The procedure is more technically demanding for the surgeon however. But, the rehab after the surgery has not changed much. It is still a pretty hard rehab program. So, if there is any chance that you are not going to do the rehab, don't do the surgery. Without the rehab, the surgery is for naught, it will fail.

With the ACL, a direct repair of the ligament is not possible. The cruciate ligaments (ACL, PCL) are located totally within the joint capsule. Thus, they are continually bathed in synovial (joint) fluid. This prevents the ligament from healing. So, it cannot just be sewn back together. It has to be removed and reconstructed with a graft. The graft can be taken from the patient's body or a banked graft can be used.



The other injuries, the LCL and biceps femoris avulsions are usually left to heal on their own. The patient is placed in a post-op/post-injury long leg range of motion brace. The patient is allowed to weight bear as tolerated. After a couple of weeks rest during which only light range of motion is allowed, the emphasis is changed to more intense range of motion and the beginning of strength training. By doing the range of motion, it tells the body which way to lay down the collagen fibers. So that the fibers are in the right orientation.

If, however, this injury was significant enough to completely avulse the LCL and biceps femoris total off the lateral femoral condyle, then surgery to reattach the ligament to the bone (using a long screw and a "crown of thorns" washer) is usually employed. In some cases, if the patient is going to have the ACL surgery, then the surgeon will go ahead and secure the LCL at the same time, even if it would not normally be necessary if the LCL along was injured.



The popliteal ligament is just left to heal on its own, due to its location and function.


The fibular fracture sounds like it just consists of the LCL and biceps femoris attachments. There is nothing that really has to be done with it specifically.



So, when should be surgery be done? It is usually recommended that the surgery be delayed until the patient's knee is no longer swollen and the patient has almost normal range of motion in the knee (it is essential to have full extension). ACL reconstructions done immediately or while the patient still has significant inflammation and swelling do not do as well post-op, as those who have waited and done the therapy to get the swelling gone and as good a range of motion as possible. The early surgeries also have a much higher rate of developing arthrofibrosis. The is a terrible condition, where the knee becomes so socked in with scar tissue, that the patient may wind up with only a few degrees of motion (usually around 10-30 degrees total).



As to a diet, you just need to eat a well rounded, balanced diet. You should have extra protein (for tissue healing), calcium, vitamin D, and magnesium. This is not a time to go on any crazy diet. You need the calories to help rebuild the tissues needed.

A big thing, do not smoke. Smoking is probably the biggest determent to wound healing there is. So, if you smoke, this would be a great time to quit.


The rehab after an ACL reconstruction is long and intense. You have to be committed to it, or you will end up with a poor outcome. The main part of therapy usually lasts about 4-6 months. But, most patients will continue to do certain parts of their therapy for many months after the formal therapy has ended. And, it may take as long as a year to 18 months before full recovery, and a final outcome is known.


It took Edgrin James, an American football pro running back two years to get back to playing again, after his ACL was reconstructed. Some players are able to get back in 6 months or so (but that is pushing it). But, these are high level athletes.

Most "normal" patients can get back to their usual daily activities in a couple of months. Sports take a bit longer.


But, again, you do not have to have surgery. If you are the type of person who rarely, if ever, plays sports and does not have to do a lot of pivoting activities in their occupations, then they probably don't need the ligament reconstructed. They usually need to keep the leg strong and have good balance, but that's all.

The main reason to reconstruct an ACL is to prevent twisting injuries that could cause damage to the articular cartilage within the knee. Repeated episodes of twisting and damaging the cartilage, can lead to accelerated degeneration in the knee (traumatic arthritis). The reconstruction is not done so that the patient can return to high level athletics. If the patient can, that's great, but the main purpose of the surgery is to try to reduce the incidence of traumatic arthritis.



So, speak with your surgeon at length about the surgery and everything else. Be wary of surgeons who just push surgery. Especially if they do not even inquire about your activity level, what you want to do, what you need to do, and how are you about doing all of the extensive rehab.

Again, if you aren't going to do the rehab, don't do the surgery.


You should be working on getting the swelling and inflammation out of the knee at the present time. You should also be working on range of motion, especially getting the knee completely straight. Full extension is the hardest to obtain, and is very critical for proper gait mechanics.

Good luck with whatever you decide to do.

Thanks for the replies guys,I'm 30 I am now in the middle of physio and all is going well.

The whole ball off the end of my fib was snapped off along with the ligament, I had surgery to repair all of this, so at this moment I am still wearing a leg brace and have flex off 90 degrees and was told today I no longer need crutches which is excellent news!

With my diet and the fact that I have quit smoking I have cut the rehab time,my knee cap seems very stable so I'm hopeful of not needing another op, will find this out on the 26th July when I speak to the consultants.

Regarding playing football I'm not that fussed about it,running I would like to do and that can be reached in approx 8'weeks or so if it carries on going as well as it has been.

So the worst is over and my life is getting back to some sort of normality, I can now walk and drive,my knee is getting better all the time and have a lot of movement in it.

I used to smoke but quit the day I got injured and have not had one since the 13th May (day of the injury)

So I'm feeling a lot better and on the mend!

I want to thank you for your advice it's been very helpful to me getting someone elses perspective on it.