What does surgery involve?

 On the day of surgery you will be admitted to the ward or surgical admission area. You will once again meet your surgeon who will ensure you are still happy to proceed and that you understand the risks and benefits of the procedure. This is a good opportunity for you to ask any further questions. You will be asked to sign a consent form if you have not already done so.

You will meet your anaesthetist who will explain the type of anaesthetic you will receive. Elbow ligament reconstruction usually requires a general anaesthetic (you will be asleep) and a nerve block so that the arm will be numb for approximately 12 hours post operatively.

Surgery is typically carried out via an incision on either side of the elbow and is 10-15cm long. If surgery is carried out within 2 weeks of an acute injury it may be possible to repair your torn ligaments using small corkscrew like bone anchors and strong stitches. Often the torn ligament cannot be repaired and they need to be reconstructed using donated tissue. Your surgeon will discuss this with you prior to the operation.

The procedure is usually done as a day case meaning you can go home on the same day as your surgery.

The wounds are repaired with stitches and covered with a splash proof dressing. The wounds should be kept dry for 10-14 days.

What happens post operatively?

Immediately after surgery your arm will be in a sling and will usually feel heavy and numb as a result of the nerve block. You will be given painkillers if you are in any pain, and these will also be provided upon discharge.

A physiotherapist will assess you to make sure that you can remove and apply the sling safely. They will provide some early exercises to help prevent stiffness of the hand, wrist and elbow.

How long is the rehabilitation process?

You will require extensive physiotherapy to maximise the benefit from your elbow operation. The final result from elbow stabilisation often takes 6-12 months to be achieved.

Physiotherapy is individualised to your specific needs and will progress with the following goals:

• Early (0-2weeks): Minimize post-operative stiffness with active finger, wrist and elbow movements. Elbow flexion & extension whilst lying supine, shoulder flexed to 90 degrees. No Forced movements

• Middle (2-6 weeks): Continue to full active range of movement under supervision of physiotherapist. Avoid elbow flexion with the shoulder abducted (away from the body). Commence isometric and proprioception exercises (from week 4)

• Late (12 weeks and beyond): Graded return to all previous functional and recreation activities.

How long will it be before I can…?

Drive 8 weeks

Desk job 2 weeks

Manual work 12 weeks

Golf 24 weeks

Racket sport 24 weeks

Contact sport 24 weeks

Repetitive overhead activity/sport 24 weeks

What are the potential risks and complications?

As with any operation, a small number of people may have problems after elbow ligament reconstruction. Most of these problems are quite minor and can be treated easily occasionally further surgery is needed.

The main risks are:

• Infection (1-2% of cases)

• Major bleeding

• Nerve injury

• Elbow stiffness

• Additional bone formation (Heterotopic ossification)

• Numbness around the surgical scar

• Failure to improve.

Is elbow ligament reconstruction always successful?

Approximately 85-90% of patients will make a good or excellent recovery. 10% will have some on-going discomfort and, perhaps, a sensation of instability, but will be satisfied with their outcome. Some patients will develop recurrent instability, sometimes following a new injury, and will require revision surgery.

The results of elbow stabilisation are therefore not guaranteed which is why your surgeon will want to ensure that all non-operative measures have been exhausted first.