Ligament Reconstruction

The knee joint, connecting the femur (thighbone) to the tibia (shinbone), is stabilized by four main ligaments: the medial collateral ligament (MCL) and lateral collateral ligament (LCL) on both sides, and the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) at the center of the knee joint, mainly for anterior-posterior stability. A ligament injury can result in knee instability and loss of function. Ligaments can be surgically reconstructed to restore stability by replacing the torn ligament with a graft. ACL and PCL injuries are commonly seen; they get injured by different mechanisms according to their respective functions:

‍ACL Reconstruction: The ACL, located at the center of the knee, prevents the tibia from sliding out in front of the femur and provides rotational stability. ACL injuries are common, especially in sports that involve sudden stops and changes in direction, such as basketball, hockey, or soccer.
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PCL Reconstruction: The PCL, located at the center of the knee behind the ACL, prevents the tibia from sliding backward. PCL injuries often occur due to a direct blow to the front of the knee, such as in a car accident or during contact sports.

Ligament reconstruction is typically performed arthroscopically, meaning the surgeon inserts a camera (arthroscope) inside the knee to perform most of the procedure instead of opening the knee joint. Small incisions are made around the knee to insert an arthroscope, which provides a visual guide, and surgical instruments. The damaged ligament is replaced with a graft, which can be an autograft (from the patient's own tissues) or an allograft (donor tissue). The surgeon typically opts for an autograft approach, replacing the torn ligament using one of the tendons from your hamstring muscles (e.g. semitendinosus), or from your quadriceps (above your kneecap). First, a small incision is made on the side of your knee, and the tendon is retrieved by the surgeon to adjust and prepare it for its new function, serving as a ligament to stabilize your joint. Then, the torn ligament is removed arthroscopically to make way for the insertion of your new autograft, which is secured with screws. As time goes on, your tendon graft will undergo ligamentization, meaning the body will adapt its structure to function as a new ACL or PCL. You don’t need to worry about losing a tendon, as it is carefully selected and your leg is supported by many stronger muscles who will be able to compensate as you use them in the long term.
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Sometimes, other structures, such as the meniscus (knee cushion), get injured as well. If that is the case, the surgeon can often address these concomitant injuries during the same arthroscopic procedure.

As with all surgeries, a ligament reconstruction carries risks, which include:
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● Joint infection
● Patellar fracture
● Weakness of knee flexion
● Knee stiffness
● Nerve injury
● Graft failure or re-injury
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General minor risks associated with surgery and anesthesia include nausea, vomiting, headaches, sore throat, and urinary retention. Major general risks include blood clots, potentially leading to heart attack or stroke, allergic reactions, and pneumonia. Your surgeon will make sure to discuss the relevant risks with you prior to your surgery and take precautions to minimize the risk of any complications

After an outpatient knee ligament reconstruction, you can typically expect to go home the same day, provided your surgeon determines that your recovery is on the right track. Since the procedure is performed arthroscopically, the scars, postoperative pain, and recovery time are typically smaller and diminished. However, regaining full mobility and strength of the knee typically takes 9 to 12 months of physical therapy exercises with avoidance of contact sports and high-impact activities such as heavy lifting and manual labor in the early stages to avoid reinjury. As such, patients typically begin rehabilitation soon after surgery with strength, agility, and balance exercises, although you may need a longer period of non-weight bearing after a PCL reconstruction. Crutches are often used for the first 1-2 weeks, and a knee brace may be recommended to protect the reconstruction. Make sure to follow your surgeon’s recommendations and your physiotherapist’s prescribed exercises for an optimal recovery; what happens after the surgery is just as important as the surgery itself.
Your follow-up visits with your surgeon and physiotherapist will help ensure your recovery is on the right track.

After an outpatient knee ligament reconstruction, you can typically expect to go home the same day, provided your surgeon determines that your recovery is on the right track. Since the procedure is performed arthroscopically, the scars, postoperative pain, and recovery time are typically smaller and diminished. However, regaining full mobility and strength of the knee typically takes 9 to 12 months of physical therapy exercises with avoidance of contact sports and high-impact activities such as heavy lifting and manual labor in the early stages to avoid reinjury. As such, patients typically begin rehabilitation soon after surgery with strength, agility, and balance exercises, although you may need a longer period of non-weight bearing after a PCL reconstruction. Crutches are often used for the first 1-2 weeks, and a knee brace may be recommended to protect the reconstruction. Make sure to follow your surgeon’s recommendations and your physiotherapist’s prescribed exercises for an optimal recovery; what happens after the surgery is just as important as the surgery itself.
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Your follow-up visits with your surgeon and physiotherapist will help ensure your recovery is on the right track.