Knee Ligament Repair and Reconstruction

A torn ligament severely limits knee movement, resulting in a person’s inability to pivot, turn or twist their leg. In some cases, the torn ligament may need to be repaired or reconstructed.

There are four major ligaments in the knee. The ligaments in the knee connect the thigh bone to the shin bone and include:

  • Anterior cruciate ligament (ACL): This ligament, located in the center of the knee, controls rotation and forward movement of the shin bone.
  • Posterior cruciate ligament (PCL): This ligament, located in the center of the knee, controls backward movement of the shin bone.
  • Medial collateral ligament (MCL): This ligament gives stability to the inner knee.
  • Lateral collateral ligament (LCL): This ligament gives stability to the outer knee.

How are knee ligaments injured?

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. However, the PCL injury usually occurs 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 these ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

How are knee ligament injuries treated?

If a knee ligament is injured, early medical treatment may include:

  • Rest
  • Applying an ice pack (to reduce swelling within hours of the injury)
  • Compression, using an elastic bandage or brace
  • Elevation
  • Pain relievers

If a ligament is torn, additional treatment might include:

  • Muscle-strengthening exercises
  • A protective knee brace (for use during exercise)
  • Activity limitations

When the knee ligament tear is severe, the knee may become unstable. A person may not be able to twist or turn the knee, and the knee may buckle or give way. Surgery to repair or reconstruct the ligament may be necessary.

What are the risks of the procedure?

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to:

  • Continued knee laxity or stiffness
  • Continued pain/dysfunction
  • Infection
  • Bleeding
  • Rare blood clots in the legs or lungs

Some individuals experience pain, limited range of motion in the knee joint and occasional swelling in the knee after surgery. Others have increased motion in the knee joint as the new ligament stretches over time.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

What is involved in the surgery?

Our orthopaedic surgeons perform knee ligament surgery on an outpatient basis, meaning there is no overnight stay in the hospital. The surgery is done under general anesthesia usually accompanied by a regional nerve blocking medication.

The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the front of the knee or hamstring, for example, is grafted into place to replace the torn ligament. The tendon graft may come from the person or from an organ donor.

The surgeon will perform the surgery using an arthroscope, a small tube-shaped instrument that is inserted into the joint. Small sockets are created in the thigh bone and shin bone, and the new ligament will be passed through the sockets and attached with an implant. New bone will eventually grow around the ligament. The small incisions will be closed with stitches or surgical staples.

Pre-surgery Checklist

Pain relief

  • Obtain and fill your prescription for pain medicine.
  • Purchase an anti-inflammatory medication such as ibuprofen (Advil, Motrin) or naprosyn (Aleve) to use after 48 hours for additional pain control, unless directed otherwise.
  • Purchase aspirin in 325mg tablets (hip or knee/ACL patients only).

Bandages

  • Purchase an elastic ACE bandage and sterile 4×4 gauze at a pharmacy (elbow, knee or ankle patients only).
  • Purchase Band-Aids or adhesive bandages.

Ice

  • A cold therapy pad/wrap may have been approved. If so, arrange to have it delivered before the date of surgery. Bring the pad and the unit in to the hospital/surgery center on the day of surgery.
  • Purchase several reusable ice packs.

Equipment

  • If applicable, obtain crutches and bring them to the hospital/surgery center on the day of surgery.
  • If applicable, obtain a brace (knee range of motion brace/shoulder immobilizer/hip brace/foot pads) prior to surgery and have it fit to the operative extremity. Bring the brace into the hospital/surgery center on the day of surgery.
  • If applicable, arrange to have a Continuous Passive Motion Machine (CPM) delivered to your home before the date of surgery or the morning after (hip or knee patients only). You will start using it the evening of surgery or the next morning at a speed that feels comfortable to you and at the range of motion prescribed.

Therapy

Formal physical therapy will be arranged, with specific therapist instructions provided at the first post-operative visit. You are to schedule an appointment with the facility to start therapy within two weeks after surgery (unless directed otherwise).

Follow-up

Schedule a post-operative appointment with your doctor within a week following the operation (unless directed otherwise).

Post-surgery Instructions

Bandages

The bandage applied to your incisions may become moist or bloodstained; however this is normal and results from fluid placed in the joint during surgery. If your bandage becomes saturated with bright red blood, please call the office. Keep the bandages dry when bathing (“sponge bathing” is the simplest and easiest). Keep the bandages in place until you are seen in the office for your first postoperative visit, where you will receive instructions regarding further bandages and wraps, as well as showering or bathing.

Activity

For the first few days after surgery, you will want to limit your activities and rest your leg. Keep your leg elevated, with a pillow under your calf, and use the cold therapy device/ice packs to minimize swelling and pain. Use the CPM (continuous motion machine) for at least 2-3 hours a session, three times daily (more if you like.) Be sure to spend at least 6 hours out of each 24-hour day with your knee fully extended in the brace (this is easiest to do while sleeping). When applying the straight leg brace, be sure to have your knee as straight as possible. When standing up or walking, use the crutches provided and have the straight leg brace applied to your leg. With the brace supporting your knee, you may bear as much weight on your foot as tolerated (unless instructed otherwise). There may be a sensation of splashing of fluid within your joint, but this is normal and should not cause concern.

Pain control

You will find that your knee is swollen and uncomfortable for the first few days after surgery. To reduce this, use the cold therapy device/ice packs and elevate the joint as instructed. You have also been provided with medication for pain relief. Use it as instructed and take it with food to avoid stomach upset. If the medication provided is inadequate, or if you are about to run out, please call the office during daily office hours. During your post-operative recovery, please keep track of how much pain medication you have remaining to ensure that you have sufficient medication for any upcoming weekends or holidays, as prescriptions are difficult to renew on weekends. You may also take ibuprofen as directed, which can be obtained over the counter.

Precautions

If you develop a fever of 101 degrees or greater, if the pain you feel is much greater than expected, or if you develop severe redness or swelling, please call the office. Some calf and ankle/foot swelling occurs in all cases, but it can become severe. If you develop a reaction to the pain medication provided, stop taking it and call the office. Avoid direct sunlight on the incisions until the scars are no longer red. Remember that although the external incisions are small, you have had a major operative procedure within your knee joint. Scientific research has shown that complete healing after knee ligament surgery takes 12-24 months. A very specific and thorough rehabilitation plan has been developed to guide you in your post-operative exercise and activities. You will begin this rehabilitation program after your postoperative visit. The plan may be modified, if necessary, based upon your individual rate of healing and recovery.

ACL Home Exercise Guide for Post-Op Recovery

If you’ve recently had ACL surgery, exercises are an important part of your recovery, in addition to a physical therapy program. Follow our home exercise guide for 1-4 weeks after surgery. The goal of these exercises is to regain neuromuscular control of the quadricep, strengthen the hip and maintain ankle range of motion on the affected leg.

acl home exercise guide