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Knee Ligament Surgery - ACL Reconstruction

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Knee Ligament Surgery – ACL Reconstruction

Overview

The knee is one of the most complex parts of your body and this joint is of vital importance for your mobility.

The knee ligaments connect your femur to your lower leg bones (tibia and fibula). Knee ligaments function by limiting the extreme rotational motions of the joint between these bones, namely the knee joint. Therefore, knee ligaments are most frequently injured during sports and sudden motions.

In the past, knee ligament injury could terminate sports life of most professional athletes. Recently, it is often possible to resume the sports life even if multiple ligaments are injured.

Anterior cruciate ligament is the most frequently injured ligament of the knee joint. The deformed or torn ligament as a result of the strain is either repaired or replaced by a tendon graft that is obtained from another part of the body.

Why is this procedure done?

The knee joint has significantly wide range of motion and the range of these motions is limited by the ligaments in and around the knee. These ligaments are extremely strong tissues and keep the bones that form the knee joint connected to each other.

Among the aforementioned ligaments, the most frequently injured one is the anterior cruciate ligament. This ligament limits the rotational motion of the knee joint and it is injured due to many reasons, including but not limited to sudden halt, sudden change of direction while running fast, jumping from a high place in wrong position and direct impact to the knee. This injury not only leads to pain, but it also causes instability of the knee joint.

If you are not a professional athlete and your condition is mild, the condition can be treated by combining medication treatment with physiotherapy. However, if more than one ligament is injured, the person is a professional athlete and the knee joint is instable, treatment option is to repair or replace the ligament. If the condition is left untreated, knee joint will lose the stability as a result of tear or deformity and subsequently, additional load will be born on the meniscus and other joint structures, resulting in other problems in them.

Risks

As the case for all surgeries, there are some risks involved in knee replacement surgery (ACL reconstruction).

Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.

These are as follows:

  • Infection – the risk of infection is usually below 1%.
  • Blood clots
  • Knee Pain
  • Weakness of muscles.
  • Stiffness of the knee joint
  • Revision surgery
  • Failure to obtain desired range of motion

When these complications occur, albeit rare, recovery time may prolong, complete recovery might fail or revision surgery might be required. You should inform your orthopedic surgeon about your concerns before the surgery.

Your surgeon will explain in detail whether those risks apply to you or if so, the rate of occurrence.

Preparation

The first phase of preoperative preparation is same in all Medicana Hospitals. Decision of knee ligament repair or replacement (ACL reconstruction) is made by your orthopedic surgeon based on a series of tests and examinations. Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not. All other treatment options, including but not limited to medications, injections, physiotherapy and other surgical procedures, are taken into consideration.

  • Review of health history
  • A detailed physical examination: your doctor will first review your symptoms and health history. In the assessment, your doctor will examine the instable knee in all aspect and compare it with the intact knee.
  • Necessary laboratory tests and radiology studies
  • Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.

A preoperative discussion with your orthopedic surgeon about knee ligament repair or replacement (ACL reconstruction) is very important. All details of the procedure, potential risks and healing period are explained.  

You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.

Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.

Surgery and early postoperative period

Reconstruction of anterior cruciate ligament is a surgery that is performed under general anesthesia. Arthroscopic surgery is preferred in all suitable patients as this technique ensures less harm to the patient, reduction of postoperative pain, and shorter hospital stay and quicker recovery. In this method, a very thin tube equipped with a small camera in one end, called arthroscope, is inserted into the knee through very small incisions.  Tears and deformities of the ligament are repaired with surgical instruments inserted through other incisions, or ligament is removed entirely and replaced by a graft that is obtained from other parts of the body. If a graft is used, the graft is securely attached to the surrounding bones with screws and similar fixation devices. Next, surgical instruments and camera are removed and small incisions are sutured.

Patients are usually discharged in the same day after the surgery.

You will be informed about the exercises you need to do, and the actions you need to avoid after discharge. You will also be informed in detail about home care (ice pack, bandage, rest, and elevation of legs) after the discharge.

You will be given pain killer(s) after the surgery in order to manage the postoperative pain. You may also need to use antibiotics to prevent a possible infection.

It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.

You should see your surgeon for follow-up visits that are scheduled before you are discharged.

If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.

Results

Always remind that postoperative pain is a natural component of the recovery. Your doctor and nurse will take necessary measures to manage your pain.

After the knee ligament surgery (ACL reconstruction), you may need physical therapy to maintain the range of motion of the knee joint as well as to strengthen muscles and increase flexibility. You will also be instructed about home exercises.

Following these rehabilitation suggestions is crucial for your knee to regain its normal function. If you follow these recommendations, the functional difference between the two knees will disappear in a few weeks.