Surgery for the ligament infront of the knee


Ligament tears are an extremely common and extremely persistent injury. They can take a long time to heal, often require physiotherapy and a temporary change in lifestyle, and can recur years later if you’re not careful. As ligaments are a key element in your musculoskeletal system, their health directly affects your quality of life and ease of movement, and any medical problems with them must be dealt with carefully and thoroughly. If non-invasive treatment does not prove effective, torn ligaments can be surgically repaired.

 

Ligaments are thick bands of connective tissue that surround and support a joint, defining its stability and range of movement. This article focuses on ligaments in the knee and ankle, the various complications that can arise, and how they can be surgically corrected.

 

Ligaments in the knee

 

There are four major ligaments present in the knee, connecting your thighbone (femur) to your shinbones (tibia and fibula).

 

The anterior cruciate ligament (ACL) is a ligament within the joint that helps stabilize the knee and controls backward and forward movement of your lower leg.

The posterior cruciate ligament (PCL) is also within the knee joint, running in the opposite direction to the ACL and helping control backward and forward movement of your lower leg.

The medial collateral ligament (MCL) runs down the outside of the joint, providing stability to the inner knee and limiting mobility of the joint from side to side.

The lateral collateral ligament (LCL) also runs down the outside of the joint, providing stability to the outer knee and limiting side-to-side motion.

 

If you are involved with or read about sports, you may have heard of ACL injuries and surgeries, as this is a common ligament injury in that sphere - accounting for 40% of all sports injuries.

Ligament injury

 

When there is a problem with ligaments in the knee, the joint can become unstable and/or weak and impact your ability to stand and walk. A sprain occurs when a ligament is injured by being stretched too far. However, sometimes a tear or a rupture occurs, which can either be complete (torn through entirely) or partial (some of the fibers of the ligament torn while others are intact. This can happen through impact (a direct blow to the joint) or when the joint is forced out of its normal range of motion (during a fall or by sudden overexertion during sport). Most knee injuries are sprains which heal quickly.

 

The anterior cruciate ligament (ACL) is the most commonly injured of the four major ligaments, and happens due to a sudden twisting motion when the feet are facing one way, but the knees turn the opposite way. Awkward landings after a jump, a sudden stop or change in direction while running or a violent collision are some examples of how this could happen. Basketball, football, rugby, skiing and tennis all have higher risks of situations that could cause ACL injuries.

The posterior cruciate ligament (PCL) is less commonly injured than the ACL, as it is stronger and sturdier. PCL injuries are caused by sudden, violent impact, such as in car accidents, when a front seat passenger’s knees are slammed against the dashboard. Falling while your knee is bent, or facing a blow to the front of the knee while your legs are stretched out, are other ways you could hurt your PCL.

 

The medial collateral ligament (MCL) which runs down the inner side of the knee is injured more often than the lateral collateral ligament (LCL), its outer-knee counterpart. These collateral ligaments are usually injured by blows to the outer side of the knee, which can occur during sports or accidents.



When do you need knee ligament repair surgery?

 

Right after the injury, you will be advised to rest the joint, apply ice packs to make the swelling go down, and compress the area with a brace or elastic bandage to prevent edema or fluid build-up, as well as provide support. You may be given painkillers, and told to elevate the affected limb.

 

Afterwards, you will be given exercises (while wearing a knee brace) to strengthen the muscles above and below your knee, to assist in providing support, and might also undergo physiotherapy.

 

If it is discovered that you are suffering from a complete ligament tear, which is causing instability and continuing to prevent you from performing normal activities (that involve the knee twisting or turning) you may be advised to undergo ligament repair surgery. If your knee is not unstable, and you are not very active, you may opt not to have surgery. However, delaying surgery may cause more extensive damage to your knee over time, so make sure you discuss this in detail with your doctor.




Before surgery:

 

A general health examination will be conducted on you before surgery. Make sure you (truthfully) tell your doctor about your food habits, whether you drink or smoke regular, all medication you are currently taking (including supplements!) and any other information they request.

 

You may be advised not to take certain medications in the week leading up to your surgery. You will also need to fast for eight hours before the surgery. Pay close attention to these instructions as they deal with your safety under anesthesia.

 

Make sure you convey any allergies - to medications or otherwise - to your doctor! Your medical history could be very important.

 

As you will definitely not be able to drive, make sure you bring someone along to look after you and take you home after the surgery! Pack a bag with what you need for a day or two, in case you are required to stay in the hospital due to complications. Better safe than sorry.

 

If you are worried about your surgery and need someone to talk to, there are several great online forums where you can read others’ experiences and ask them questions. Make sure you pay it forward by sharing your own experiences after you recover, as it could be of huge help to others who are trying to connect with others about their own upcoming surgeries!

 

 

What happens during knee ligament reconstruction surgery?

 

Knee ligament reconstruction surgeries involve removing a piece of a nearby healthy tendon (such as from the kneecap or hamstring) and grafting it in place of the torn ligament. The tendon graft may also come from a suitable organ donor.

 

These surgeries may either be performed as outpatient procedures (releasing you on the same day) or involve some hospital stay. They can be carried out either under general anesthesia or spinal anesthesia (which numbs you from the waist down). Make sure you discuss all of these details in advance with your doctor.

 

A small incision will be made near your knee, through which your doctor will insert an arthroscope - a thin, metal tube bearing a light and camera on its end. This allows the surgeon to see inside the joint via an eyepiece or a screen in the operation theater. Tiny surgical instruments can be used alongside an arthroscope, through other small incisions in the vicinity.

 

The doctor will drill small holes in the bone where the ligament was attached, thread in the graft and screw or staple it into place. The bone will eventually regenerate around the new graft. The incisions will then be sutured or stapled close, and the area bandaged.


 

Recovery

 

Once you have woken up and are stable, you will be discharged. You will have a  knee immobilizer, and be provided crutches. You will be given specific instructions for bathing, moving around and so on, and provided with painkillers. Make sure you follow your doctor’s instructions carefully!

 

You may be told to keep your leg elevated for a few days, to prevent swelling. Your knee may feel tight and stiff - this is because of the new tendon. After physiotherapy and stretching over a period of time, this should stop. Any abnormalities during your recovery, such as fever, redness, swelling, fluid or blood draining from your incisions, severe pain, and so on should of course be reported to your doctor immediately!

 

Your mobility will be quite limited, and you will need to have someone at home who can assist you while you recover. After several weeks, you will begin physiotherapy to regain strength and mobility in your joint. Recovery can take several months, so be patient! Ligaments heal slowly, but it is very important that they heal thoroughly so that they don’t recur in the same spot. Shah Rukh Khan had to undergo arthroscopic surgery on his knee after injuring it multiple times over the years, as it never had a chance to heal properly! A year after the surgery, he is still undergoing physiotherapy. So make sure you give yourself time out to heal.




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