Knee Ligament Repair
What is knee ligament repair?
Ligaments are bands of tough, elastic connective tissue that surround a joint to give
support and limit the joint's movement.
When ligaments are damaged, the knee joint may become unstable. Ligament damage often
happens from a sports injury. A torn ligament severely limits proper 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:
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Anterior cruciate ligament (ACL). This ligament controls rotation and forward movement of the tibia (shin bone).
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Posterior cruciate ligament (PCL). This ligament controls backward movement of the tibia (shin bone).
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Medial collateral ligament (MCL). This ligament gives stability to the inner knee.
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Lateral collateral ligament (LCL). This ligament gives stability to the outer knee.
Why might I need a knee ligament repair?
The ACL is located toward the front of the knee. It is the most common ligament to
be injured. The ACL is often stretched or torn during a sudden twisting motion (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 located toward the back of the knee. It is also a common knee ligament
to be injured. But the PCL injury usually happens with sudden, direct impact, such
as in a car accident or during a football tackle.
The MCL is located on the inner side of the knee. It is injured more often than the
LCL, which 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, such as when playing
hockey or football.
Early medical treatment for knee ligament injury may include:
A knee ligament tear may be treated with the following:
Knee ligament repair is a treatment for a complete tear of a knee ligament that results
in instability in the knee. People with a torn knee ligament may be unable to do normal
activities that involve twisting or turning at the knee. The knee may buckle or “give-way.”
If medical treatments are not satisfactory, ligament repair surgery may be an effective
treatment.
The surgery to correct a torn knee ligament involves replacing the ligament with a
piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted
into place to hold the knee joint together. The tendon graft may come from the person
(autograft) or from an organ donor (allograft).
There may be other reasons for your healthcare provider to recommend a knee ligament
repair.
What are the risks of knee ligament repair?
As with any surgery, complications can happen. Some possible complications are:
Some people may experience pain, limited range of motion in the knee joint, and occasional
swelling in the knee after surgical ligament repair. 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 healthcare provider before the procedure.
How do I get ready for a knee ligament repair?
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Your healthcare provider will explain the procedure to you and offer you the chance
to ask any questions that you might have about the procedure.
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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.
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In addition to a complete medical history, your healthcare provider may perform a
complete physical exam to ensure you are in good health before undergoing the procedure.
You may undergo blood tests or other diagnostic tests.
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Tell your healthcare provider if you are sensitive to or are allergic to any medicines,
latex, tape, and anesthetic agents (local and general).
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Tell your healthcare provider of all medicines (prescribed and over-the-counter) and
herbal supplements that you are taking.
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Tell your healthcare provider if you have a history of bleeding disorders or if you
are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines
that affect blood clotting. It may be necessary for you to stop these medicines before
the procedure.
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If you are pregnant or suspect that you are pregnant, you should notify your healthcare
provider.
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You will be asked to fast for 8 hours before the procedure, generally after midnight.
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You may receive a sedative prior to the procedure to help you relax. Because the sedative
may make you drowsy, you will need to arrange for someone to drive you home.
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You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
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Arrange for someone to help around the house for a week or two after you are discharged
from the hospital.
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Based on your health condition, your healthcare provider may request other specific
preparations.
What happens during a knee ligament repair?
Knee ligament repair may be done on an outpatient basis or rarely as part of your
stay in a hospital. Procedures may vary depending on your condition and your healthcare
provider’s practices.
Knee ligament repair may be performed while you are asleep under general anesthesia,
or while you are awake under spinal anesthesia. If spinal anesthesia is used, you
will have no feeling from your waist down. Your healthcare provider will discuss this
with you in advance.
Generally, knee ligament repair surgery follows this process:
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You will be asked to remove clothing and will be given a gown to wear.
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An intravenous (IV) line may be started in your arm or hand.
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You will be positioned on the operating table.
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The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing,
and blood oxygen level during the surgery.
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The skin over the surgical site will be cleansed with an antiseptic solution.
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The healthcare provider will make several small incisions in the knee area.
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The healthcare provider will do the surgery using an arthroscope (a small tube-shaped
instrument that is inserted into a joint). The healthcare provider may reattach the
torn ligament or reconstruct the torn ligament by using a portion (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 from an organ donor (allograft).
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The healthcare provider will drill small holes in the tibia and femur where the torn
ligament was attached.
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The healthcare provider will thread the graft through the holes and attach it with
surgical staples, screws, or other means. Bone eventually grows around the graft.
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The incision will be closed with stitches or surgical staples.
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A sterile bandage or dressing will be applied.
What happens after a knee ligament repair?
After the surgery, you will be taken to the recovery room for observation. Your recovery
process will vary depending on the type of anesthesia that is given. Once your blood
pressure, pulse, and breathing are stable and you are alert, you will be taken to
your hospital room or discharged to your home. Knee ligament repair is usually done
on an outpatient basis.
You may be given crutches and a knee immobilizer before you go home.
Once you are home, it is important to keep the surgical area clean and dry. Your healthcare
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 recommended by your healthcare provider. Aspirin
or certain other pain medicines may increase the chance of bleeding. Be sure to take
only recommended medicines.
To help reduce swelling, you may be asked to elevate your leg and apply an ice bag
to the knee several times per day for the first few days. Your healthcare provider
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 healthcare provider if you have any of the following:
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Fever or chills
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Redness, swelling, bleeding, or other drainage from the incision site
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Increased pain around the incision site
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Numbness or tingling in the leg
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Calf swelling or tenderness
You may resume your normal diet unless your healthcare provider advises you differently.
Because of the limited mobility, it may be hard for a few weeks to resume your normal
daily activities. You may need someone at home to assist you. You should not drive
until your healthcare provider tells you to. Other activity restrictions may apply.
Full recovery from the surgery and rehab may take several months.
Your healthcare provider may give you additional or alternate instructions after the
procedure, depending on your particular situation.
Next steps
Before you agree to the test or the procedure make sure you know:
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The name of the test or procedure
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The reason you are having the test or procedure
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What results to expect and what they mean
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The risks and benefits of the test or procedure
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What the possible side effects or complications are
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When and where you are to have the test or procedure
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Who will do the test or procedure and what that person’s qualifications are
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What would happen if you did not have the test or procedure
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Any alternative tests or procedures to think about
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When and how you will get the results
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Who to call after the test or procedure if you have questions or problems
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How much you will have to pay for the test or procedure