Inova - Knee Ligament Repair or Reconstruction (2024)

What is knee ligament repair or reconstruction?

Ligaments are bands of tough, elastic connective tissue that surround a joint to give support. They also limit the joint's movement.

The knee joint may become unstable when ligaments are damaged. Ligament damage often happens from a sports injury. A torn ligament severely limits correct knee movement. This results in the inability to pivot, turn, or twist the leg. Surgery is a choice to fix a torn ligament if other treatment does not work.

The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone). There are 4 major ligaments in the knee:

  • Anterior cruciate ligament (ACL). This controls rotation and forward movement of the tibia (shin bone).

  • Posterior cruciate ligament (PCL). This controls backward movement of the tibia (shin bone).

  • Medial collateral ligament (MCL). This gives stability to the inner knee.

  • Lateral collateral ligament (LCL). This gives stability to the outer knee.

Inova - Knee Ligament Repair or Reconstruction (1)

Why might I need a knee ligament repair or reconstruction?

The ACL is toward the front of the knee. It's the most common ligament to be injured. The ACL is often stretched or torn during a sudden twisting motion. For instance, when the feet stay planted one way, but the knees turn the other way. Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The PCL is toward the back of the knee. It's also a common knee ligament to be injured. But the PCL injury often happens with sudden, direct impact. This can happen in a car accident or during a football tackle.

The MCL is on the inner side of the knee. It's injured more often than the LCL,. This is on the outer side of the knee. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the side of the knee. This includes when playing hockey or football.

Early medical treatment for knee ligament injury may include:

  • Rest

  • Ice packs (to reduce swelling that happens within hours of the injury)

  • Compression (from an elastic bandage or brace)

  • Elevation (keeping it raised)

  • Pain relievers

A knee ligament tear may be treated with the following:

Knee ligament repair or reconstruction is a treatment for a tear of a knee ligament that results in instability in the knee. This repair or reconstruction is done by an orthopedic surgeon. This is a surgeon who specializes in treating bone, muscle, joint and tendon problems. People with a torn knee ligament may be unable to do normal activities that require twisting or turning at the knee. The knee may buckle or “give way.” Repair or reconstruction surgery may be an effective treatment if medical treatments don't work well.

The surgery to fix a torn knee ligament with a repair is done by stitching (suturing) the torn ligament. The surgery to correct a torn knee ligament with reconstruction is done by replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for instance, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft). Or it may come froman organ donor(allograft).

There may be other reasons for yourhealthcare provider to advise a knee ligament repair or reconstruction.

What are the risks of knee ligament repair or reconstruction?

As with any surgery, complications can happen. Some possible complications are:

  • Bleeding

  • Infection

  • Blood clots in the legs or lungs

Some people may have pain, limited range of motion in the knee joint, and some swelling in the knee after surgical ligament repair or reconstruction. Others have increased motion in the knee joint as the graft stretches over time.

There may be other risks depending on your specific health condition. Talk about any concerns with your surgeon before the procedure.

How do I get ready for a knee ligament repair or reconstruction?

  • Yoursurgeon will explain the procedure to you. Ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • In addition to a complete health history, yourhealthcare provider may do a complete physical exam. This is to make sure that you are in good health before having the procedure. You may have blood tests or other diagnostic tests.

  • Tell yoursurgeon if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).

  • Tell yoursurgeon about all medicines (prescribed and over-the-counter) that you are taking. This includes vitamins, herbs, and other supplements.

  • Tell your surgeon if you have a history of bleeding disorders. Or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

  • Tell your surgeon if you are pregnant or think you could be. .

  • Follow all directions you are given for not eating or drinking before your surgery.

  • You may receive a sedative before the procedure to help you relax. You will need to arrange for someone to drive you home. This is because the sedative may make you drowsy.

  • You may meet with a physical therapist before your surgery to discuss rehabilitation.

  • Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

  • Yourprovider may request other specific preparations based on your health condition.

What happens during a knee ligament repair or reconstruction?

Knee ligament repair or reconstruction may be done on an outpatient basis. In rare cases it may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your surgeon's practices.

Knee ligament repair or reconstruction may be done while you are asleep under general anesthesia. Or it may be done while you are awake under spinal anesthesia. You will have no feeling from your waist down if spinal anesthesia is used. Your surgeon will discuss this with you in advance.

Generally, knee ligament repair or reconstruction surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.

  2. An IV (intravenous) line may be started in your arm or hand.

  3. You will be positioned on the operating table.

  4. The anesthesiologist will continuously keep track of your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

  5. The skin over the surgical site will be cleansed with an antiseptic solution.

  6. The surgeon will make several small incisions in the knee area.

  7. The surgeon will do the surgery using an arthroscope. This is a small tube-shaped tool that is inserted into a joint. The surgeon may reattach the torn ligament or reconstruct the torn ligament by using a part (graft) of the patellar tendon (that connects the kneecap to the tibia), the hamstring tendon (from the back of the thigh), or other autografts. The tendon graft may come from the person (autograft). Or it may come from an organ donor(allograft).

  8. The surgeon will drill small holes in the tibia and femur where the torn ligament was attached.

  9. The surgeon will thread the graft through the holes. Then it will be attached with surgical staples, screws, or other means. Over time, bone grows around the graft.

  10. The incision will be closed with stitches or surgical staples.

  11. A sterile bandage or dressing will be applied.

What happens after a knee ligament repair or reconstruction?

You will be taken to the recovery room to be watched after the surgery. Your recovery process will vary depending on the type of anesthesia that is given. You will be taken to your hospital room or discharged to your home once your blood pressure, pulse, and breathing are stable and you are alert. Knee ligament repair or reconstruction is often done on an outpatient basis.

You may be given crutches and a knee immobilizer before you go home.

It's important to keep the surgical area clean and dry once you are home. Yourhealthcare provider will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as advised by your surgeon. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only advised medicines.

You may be asked to raise (elevate) your leg and apply an ice bag to the knee several times per day for the first few days to help reduce swelling. Yourprovider will arrange for an exercise program to help you regain muscle strength, stability, and range of motion. Physical therapy is a key part of recovery.

Tell your surgeon if you have any of the following:

  • Fever or chills

  • Redness, swelling, bleeding, or other drainage from the incision site

  • Increased pain around the incision site

  • Numbness or tingling in the leg

  • Calf swelling or soreness

You may resume your normal diet unless yourprovider advises you differently.

It may be hard for a few weeks to resume your normal daily activities because of the limited mobility. You may need someone at home to help you. You should not drive until your provider tells you to. Other activity restrictions may apply. Full recovery from the surgery and rehab may take a few months.

Yoursurgeon may give you additional or alternate instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or procedure make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure

Online Medical Reviewer:Rahul Banerjee MD
Online Medical Reviewer:Raymond Turley Jr PA-C
Online Medical Reviewer:Stacey Wojcik MBA BSN RN

Date Last Reviewed:10/1/2023

© 2000-2024 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

Inova - Knee Ligament Repair or Reconstruction (2024)

FAQs

Is ACL repair or reconstruction better? ›

The success rates of primary ACL repair are generally poorer than those of ACL reconstruction, particularly for athletes or individuals with high activity levels. The repaired ACL is more prone to re-tearing and may not provide the same stability as a reconstructed ACL.

What is the difference between reconstruction and repair of ligaments? ›

Reconstruction has a high success rate but can take 6-12 months for a full recovery. ACL repair seeks to keep the patient's ligament in place to promote self-healing. The ligament may also require stem cells. The goal with ACL repair is a faster recovery time and reduced chances of arthritis in the future.

What is the most frequently surgically repaired knee ligament? ›

The ACL is toward the front of the knee. It's the most common ligament to be injured. The ACL is often stretched or torn during a sudden twisting motion. For instance, when the feet stay planted one way, but the knees turn the other way.

Can knee ligaments be repaired? ›

A torn ACL cannot be repaired by stitching it back together, but it can be reconstructed by attaching (grafting) new tissue on to it. The ACL can be reconstructed by removing what remains of the torn ligament and replacing it with a tendon from another area of the leg, such as the hamstring or patellar tendon.

What are the pitfalls of ACL reconstruction? ›

Possible complicationsFrequency
Tear of the newly grafted ACL (over a period of up to 14 years)About 60 out of 1,000
Infection in the knee jointAbout 5 out of 1,000
Deep vein thrombosis (DVT)About 20 out of 1,000
Pulmonary embolismAbout 1 out of 1,000
Feb 21, 2023

What is the success rate of patients that have reconstructive ACL surgery? ›

Anterior cruciate ligament (ACL) tears are a common knee injury that often requires surgery to reconstruct the torn ligament. Although ACL reconstruction surgeries have an 80% to 90% success rate,1 some patients may struggle with the decision to have it because of the complications that may follow.

What's the hardest knee surgery to recover from? ›

ACL reconstruction surgery is a common procedure used to repair a torn anterior cruciate ligament (ACL) in the knee. Recovery can be challenging because the knee is a complex joint that is used frequently in daily activities.

What is the hardest knee ligament to tear? ›

While not always the case, an ACL tear is in most cases going to be the more severe injury. It is considered worse than tearing the MCL because ACL tears are in general more complex to treat and require a longer recovery time after surgery.

What is the most serious ligament in the knee? ›

Anterior cruciate ligament (ACL) is the most commonly injured knee ligament. It connects the thigh bone to the shin bone. Posterior cruciate ligament (PCL) also links the thigh bone to the shin bone in the knee.

What happens if a torn ligament is not repaired? ›

A fully torn ligament, or grade 3 tear, can cause chronic pain and joint instability. Complete tears rarely heal naturally. Since there's a disconnect between the tissue and any chance of blood supply, surgery is needed. Surgery also helps the joint heal correctly and reduces the chances of re-injury.

How painful is knee ligament surgery? ›

ACL surgery can be very painful depending on the type of autograft harvested and the complexity of surgery undertaken. The postoperative pain can be reduced using local anaesthetic infiltration around the knee joint after the surgery as well as using peripheral nerve blocks.

Is walking good for torn knee ligaments? ›

Always try to walk normally – i.e. heel down first. In the early stages after injury excessive weight bearing may cause increased pain and swelling. You may be given crutches for a short time to help with this. Gradually increase your activity as the pain and swelling subside.

Which surgery is better for ACL? ›

ACL reconstruction is the current standard-of-care surgical treatment for ACL tears. This procedure typically uses a graft, or a piece of tissue, that is placed in the knee to replace the torn ACL in a minimally invasive surgery that uses small incisions. Most ACL surgeries performed at HSS are ACL reconstructions.

Is reconstructed ACL stronger? ›

Conclusion: An ACL graft after a reconstruction surgery is initially stronger, but over time becomes weaker, and eventually is almost as strong as your original ACL. These changes occur as a result of the body's natural reaction to the new ACL graft.

What is the best replacement for the ACL? ›

The patellar tendon and hamstring autografts are the most common choices for ACL reconstruction. The patellar tendon runs from the knee cap (patella) to the lower leg bone (tibia). Surgeons have the most experience with this autograft and it is the most widely used.

What happens if a torn ACL is not repaired? ›

If nothing is done, the ACL injury may turn into chronic ACL deficiency. Your knee may become more and more unstable and may give out more often. The abnormal sliding within the knee also can hurt cartilage. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis.

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