Ligament Reconstruction of the knee
Ligaments are strong bands of fibrous connective tissue that connect bone to bone. In regards to the knee joint, there are four ligaments that support and limit the movement about the knee, and these can be injured through sport and trauma. The ligaments about the knee joint are the:
- Anterior Cruciate Ligament (ACL) which controls rotation and forward movement of the tibia (shin bone);
- Medial Collateral Ligament (MCL) which provides stability to the inner side of the knee;
- Lateral Collateral Ligament (LCL) which provides stability to the outer side of the knee; and
- Posterior Cruciate Ligament (PCL) which controls backward movement of the tibia (shin bone).
A reconstruction of the ACL is the most common orthopaedic surgery of the ligaments of the knee joint.
A reconstruction of the ligaments of the knee may be considered as a surgical treatment option in patients who have ruptured or torn any of these ligaments.
When the ACL is ruptured patients may experience symptoms such as giving way or instability of the knee. Repair of a ruptured ligament is not indicated in all patients. A reconstruction may be indicated in patients who have a continued feeling of their knee giving way, who would like to continue to be involved in sports requiring pivoting, or patients who perform squatting and heavy manual work in their job. If you are not involved in sports or perform heavy manual work then you may not require reconstructive surgery. For those individuals that do not proceed to reconstructive surgery there are other treatments that can assist in managing their knee condition such as muscle strengthening exercise prescribed by a physiotherapist, use of a protective knee brace during exercise and activity modification.
Reconstruction of a knee ligament involves replacing the ruptured ligament with a substitute ligament, usually from your hamstring tendon. The surgery is performed arthroscopically or through ‘keyhole’ surgery.
Making the decision to proceed to an ACL reconstruction is a collaborative one between the patient and orthopaedic surgeon, Dr Prodger. The patient is able to make an informed choice to proceed following a thorough discussion of the benefits of surgery and the risks of surgery.
Frequently Asked Questions
The aim of reconstructive surgery to the knee ligaments is to provide stability to the knee joint to allow for higher-level functional activities requiring rotation, such as sports (for example football, netball, skiing) or a return to heavy manual work.
As with any surgery there are risks and complications that may occur when having a Knee Ligament Reconstruction. It is important that you understand these risks prior to proceeding with the surgery. The following risks are the most usual seen in ACL reconstruction surgery:
- Infection requiring antibiotics and possible further procedures 0.5%
- Deep venous thrombosis (blood clot in veins) <1%
- Failure of the graft with recurrence of knee instability 1%
- Stiffness of the knee joint <1%
For optimal outcomes following reconstructive surgery of the knee it is recommended that prior to your surgery you see a physiotherapist who can advise on exercises to optimize quadriceps and hamstring strength.
It is important that prior to your surgery you look after your skin and do no have any scratches, cuts or abrasions to minimise risk of a skin infection.
Cease medications such as ASPIRIN, WARFARIN or Fish oil at least ten days prior to your surgery.
Reconstructive surgery of the knee is an overnight procedure and patients are usually discharged the day after surgery with crutches and pain medication.
You will see a physiotherapist before you leave hospital to begin rehabilitation exercises. Most patients only need crutches for a few days to a week, and can fully weight bear through the operated knee.
You will be discharged home with dissolvable sutures/steristrips with a waterproof dressing covering the wound and a Tubigrip compressive bandage.
Your wound will be reviewed at your post operative appointment with Dr Prodger, which is usually 10 – 14 days after your surgery. It is important to manage the swelling by elevating the knee and icing it for 20 minutes at a time twice a day in the first 2 weeks.
For optimal outcomes after reconstructive surgery of the knee it is important to start your rehabilitation with a physiotherapist before surgery.
The initial aims of physiotherapy in the first two weeks after surgery are to regain movement of the knee, minimise swelling and reactivate quadriceps and hamstrings muscle. Your physiotherapist will be provided with Dr Prodger’s rehabilitation protocol as a guide following reconstructive surgery of the knee.
As a general guide gentle exercise such as walking and swimming can begin as early as possible. Exercise such as cycling on an exercise bike can begin at approximately 3-4 weeks and jogging at 3 months. A return to sport is usually achieved between 8 and 10 months after surgery.
However prior to commencement of a return to exercise and sport activities it is recommended this be discussed with Dr Prodger and your physiotherapist to ensure you are ready. Dr Prodger will monitor your rehabilitation with regular reviews particularly in the first 6 months.
Most patients return to driving within 2 to 3 weeks.
Returning to work after your surgery depends upon the nature of your work (for example sedentary or manual work), whether suitable duties are available and your recovery. Your return to work is best reviewed with Dr Prodger at the two-week postoperative appointment.
