Why this operation has been suggested¶
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific injury. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your elbow, and arrange scans if they are needed to work out which ligament is injured.
This operation rebuilds or repairs a stretched or torn ligament on the side of your elbow. The ligament normally holds the joint steady as you bend and straighten your arm. When it fails, the elbow can click, lock, or feel as though it might give way, and some people develop wear-and-tear arthritis over time.
For long-standing problems we usually try non-operative care first, such as activity change, physiotherapy or hand therapy, and splinting. Surgery is considered when that has not given enough improvement. For a fresh injury with a dislocation or fracture, surgery may be recommended straight away.
The aim is a stable elbow that moves well, with less pain and better use of your arm. Range of motion is reliably preserved or improved, with rapid improvement in the first 2 to 4 months.
Before the operation¶
In the weeks before surgery we confirm the plan with scans such as an X-ray, MRI (a scan that shows soft tissues like ligaments) or ultrasound. These show which ligament is injured and help us plan the repair. You will need to stop eating and drinking seven hours before your operation time. We ask for seven hours so we can bring you forward if the theatre list runs early; your surgeon will confirm your exact fasting time. Some medicines need to be paused before surgery, and we will tell you which ones and when. Bring a list of your current medications, arrange a lift home, and wear loose, comfortable clothing with sleeves that slide over your elbow. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the specialist who gives the anaesthetic).
On the day¶
You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist, who reviews your health and answers any last questions. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.
When the operation is finished, you wake up in the recovery area. Nurses stay with you and monitor you while the anaesthetic wears off. Once you are stable, you either move to a ward or go home the same day, depending on the procedure and how your recovery is going. If you have a lift arranged, as noted in the section before this one, that person can take you home when the team says you are ready.
What the operation involves¶
The plan for your operation depends on which ligament is injured and how badly. Your surgeon works out which structures need repair before starting, because that is what keeps the elbow stable afterwards.
Most operations use a cut over the bony point on the inside or outside of your elbow, about 5 cm long. Through this, your surgeon reaches the torn ligament. If the ligament is healthy enough, it is stitched back onto the bone. A ribbon of strong tape can be added alongside the stitches as an internal brace, a scaffold that supports the ligament while it heals. If the ligament is too frayed or stretched to hold stitches, your surgeon rebuilds it instead, using a piece of donor tendon or a tendon taken from your own wrist through a small 1 cm cut at the wrist crease. The new ligament is anchored to the bones of the joint so it holds firm as you bend and straighten.
If your elbow keeps coming out of joint, or the injury is more complex, your surgeon may add a temporary internal stabiliser. This is a small frame that holds the joint in place from the outside while still letting you move. It is removed in a later, shorter operation once the ligaments have healed. If fractures are present, they are fixed first, then the ligaments are repaired or rebuilt.
Some repairs can be done through keyhole (arthroscopic) surgery instead, using a small camera. This suits only some injuries. If the torn ligament is too frayed, your surgeon will switch to the open technique during the same operation.
The cut is closed with stitches and covered with a dressing.
After the operation¶
You wake up in the recovery ward, where nurses check your elbow, your dressings and your pain. Pain relief is given as you need it, and the team will ask you often how you are feeling. Your arm rests in a sling and the wound is covered with a dressing that stays on until we tell you what to do with it. Keep the dressing clean and dry. A nurse will help you sit up, stand and walk short distances, usually within the first day. Someone should stay with you for the first 24 hours after you get home. Your team will tell you whether you go home the same day or stay one night in hospital.
Recovery¶
For the first few days your elbow will be sore and swollen, and the skin may feel bruised. Rest, keeping your hand raised when you sit, and the pain relief prescribed for you all help. The discomfort settles steadily as the healing gets going.
You will go home with your arm in a sling. You can move your fingers, wrist and shoulder freely while the elbow itself settles. Your surgeon will tell you when to start gentle elbow movement, and hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby directs your exercises and makes any splint you need. Early on, avoid lifting with that arm, pushing up from chairs, and anything that could twist or knock the elbow. Sleeping on your back with the arm propped on pillows is often more comfortable than lying on the sore side.
As the weeks pass, movement returns first, then strength. You will find everyday tasks come back in stages: dressing, eating, typing, then light household jobs. Once your surgeon clears you to drive, the usual rules apply: no driving while you are in a sling, you must be able to hold the wheel with both hands and react in an emergency stop, and you must be off strong pain medication. See our guide on driving after upper-limb surgery for more detail.
Return to work and sport depends on what your arm can do, not on the calendar. Your timeline may differ from others, and your surgeon and hand therapist will guide you at each review.
What can go wrong¶
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Sometimes the elbow can still feel loose or unsteady after surgery. You might notice clicking, a feeling that the joint might give way, or the same slipping sensation you had before the operation. If that happens, bring it up at your next review so the team can check how well the ligament is holding.
If a temporary internal stabiliser is used to hold the joint in place, it sometimes needs to be taken out earlier than planned. You may notice rubbing or soreness around the frame, or find turning your forearm, such as turning a door handle or a screwdriver, feels stiffer than expected. Tell the clinic if this bothers you; removing the frame is a shorter operation.
When a tendon graft is taken from your own wrist, the spot where it was taken from can stay tender. You might feel an ache there when you grip or lean on that wrist. Mention it at review if it does not settle.
The nerve that runs along the inside of your elbow can become irritated after surgery. This can feel like pins and needles, numbness, or an electric zing into your ring and little fingers. If you notice new numbness or weakness in your hand, call the clinic rather than waiting for your next appointment.
Rebuilding the ligament on the outside of the elbow carries a higher chance of a setback around the time of surgery than some other elbow operations. Watch for a deep, throbbing pain that does not ease with simple painkillers, redness spreading out from the wound, or sudden swelling. Contact the clinic promptly if any of these appear, or go to the emergency department if you cannot reach anyone.
If a donor tendon is used instead of your own, there may be a slightly greater chance the new ligament stretches or fails over time. Your surgeon will discuss which graft suits you before the operation.
The complications table on this page lists typical rates if you want the specifics.
When to call us¶
Call us if you have a fever, if the wound becomes more red or starts leaking fluid, or if pain suddenly gets much worse. Go to emergency if you have swelling or pain in your calf, or shortness of breath, as these can signal a blood clot. Call us straight away if your hand feels numb, if you cannot move your arm, or if your elbow feels like it is slipping out of joint again. If you cannot reach anyone, go to the emergency department.