What are the key steps in the knee ligament reconstruction process? Reconstruction of the ligaments of the knee joint is an advanced surgical procedure that can restore full function to your knee. From the article, you will learn exactly what this procedure is, why ligaments are so important for knee stability, and when reconstruction is indicated. We will also discuss how the preparation for the surgery, the procedure itself and the key elements of post-operative rehabilitation. Learn all the important aspects and how you can return to full activity. Read on to discover the details!
From this article you will learn:
- Knee Joint Ligament Reconstruction: What Is It?
- Course of the Anterior Cruciate Ligament Reconstruction Process
- Possible Complications and Field of Rehabilitation
Knee Joint Ligament Reconstruction: What Is It?
Ligament reconstruction of the knee joint is an advanced surgical procedure to restore the continuity of damaged ligaments and their attachments, usually anterior cruciate ligament (90% cruciate ligament injuries). This type of surgery is crucial for restoring adequate stability to the knee joint and preventing further damage and the development of degenerative changes. This procedure is carried out most often by arthroscopic technique, which minimizes the risk of infection and speeds up the patient's healing process.
Until recently, reconstructive surgery was indicated for patients who were young, athletes or those wishing to return to regular physical activity. Such selective treatment led to secondary damage to the remaining structures of the knee joint. Currently, we now know that even less active, older people are eligible for ligament reconstruction surgery.
If the procedure is delayed, the risk of damage to other structures of the joint is greatly increased, most often the cartilage and meniscus are affected, leading to the acceleration of osteoarthritis, or gonarthrosis. With reconstruction, the anatomical and biomechanical function of the ligament can be restored, which is crucial for the proper functioning of the joint.
Importance of Ligaments in the Knee Joint
Ligaments in the knee joint play a key role in ensuring its stability and proper mobility. The anterior cruciate ligament (ACL) along with the posterior cruciate ligament (PCL) and collateral ligaments (MCL and LCL) form a complex of structures that stabilize the knee. Connecting the femur to the tibia, these ligaments act as stabilizers for movements taking place in the sagittal and frontal planes, as well as limiting rotational movements, which is essential during daily activities and intensive sports.
Flexion and extension movements are secured by the cruciate ligaments, while in the frontal plane the joint is stabilized by the collateral ligaments (MCL and LCL). Without the proper functioning of the ligaments, the knee joint becomes unstable, which can lead to injuries to the other structures of the joint.
When is Reconstruction Indicated?
Reconstruction of the ligaments of the knee joint, especially the anterior cruciate ligament, is recommended in cases of Total or partial rupture, with perceived instability of the knee joint. The need for surgery therefore depends on the degree of damage and the lifestyle of the injured person. There are three degrees of ligamentous damage:
- Grade I light - indicates damage to a small number of fibers, the physiological length of the ligament is increased, but the joint is still stable,
- Grade II - Moderate - indicates that the continuity of the predominant fibers has been interrupted, the remaining preserved part of the ligament has increased in length, leading to its failure,
- Grade III severe - indicates a complete rupture of the continuity of the ligament and detachment of its attachment, the ligament is completely inoperable, there is an increased risk of damage to other structures.
Taking into account the lifestyle of the patient himself, the indication for the procedure may also be the nature of the work performed or the desire to return to sport, requiring high stability of the knee joint, and regularly occurring symptoms that reduce quality of life, such as pain and swelling.
Adequate and accurate diagnosis of the damage to the knee joint allows the earliest possible introduction of a series of procedures necessary to characterize the damage in order to combat the effects of the injury in the best possible way.
If cruciate ligament damage is suspected, an effective diagnostic scheme is based on history, physical examination and imaging. In this case, the most reliable examination will be MRI (MRI). The physical examination consists of Patient observation, palpation and structure-specific clinical diagnostic tests performed by both doctors and physiotherapists.
The risk factors contributing to ligamentous damage are many. Most often, we talk about the multifactorial aspect contributing to the damage, the basis of which may relate to the interaction of neuromuscular, biomechanical, anatomical, geometrical or hormonal factors.
Ignoring such an injury can lead to further damage within the joint. Isolated ligamentous injuries to the cruciate ligaments are rare. Most often, this injury is associated with damage to the collateral ligaments (MCL and LCL) and meniscus (MM and ML) due to their anatomical connections. A completely ruptured ACL ligament, unfortunately, does not exhibit self-healing capabilities.
Reconstructive surgery should be performed approximately 3 weeks after the injury, however, taking into account modern research, this value is not established. It is assumed that the appropriate period for surgery is when the swelling has decreased and the range of mobility of the injured region has been restored.
In order to prevent permanent damage and allow the patient to return to full mobility, it is important to stay in contact with specialists at all times to choose an individualized treatment, whether it be surgery or conservative treatment.
Course of the Anterior Cruciate Ligament Reconstruction Process
Anterior cruciate ligament (ACL) reconstruction is an advanced surgical procedure aimed at restoring stability to the knee joint after it has been damaged. The process begins with patient preparation, through the surgical procedure itself, to full rehabilitation. Using arthroscopic techniques, the procedure is less invasive, shortening recovery time and reducing pain.
The purpose of performing arthroscopic ACL reconstruction surgery is to Stabilization of the knee, prevention of further damage and improvement of the patient's comfort related to regaining the ability to return to full functional capacity. Anterior cruciate ligament reconstruction involves removing the damaged ligament and placing a graft in its place, which can come from the patient (autograft) or from a donor (allograft).
Thus, the general division of anterior cruciate ligament reconstruction procedures is based on the origin of the transplanted graft. We distinguish between:
a) Autologous transplants- performed using tendons from the body of the patient undergoing reconstruction:
- Reconstruction from ST and GR - using the tendons of the semitendinosus (ST, semitendinosus) and gastrocnemius (GR, gracilis) muscles,
- Reconstruction with BTB (bone-tendon-bone) - which uses a fragment of the patellar ligament along with its bony components,
- Reconstruction with mQF - Using 1/3 of the tendon of the quadriceps muscle of the thigh and the bony block of the proximal part of the patella.
(b) Allogeneic transplants - performed using grafts from another organism or artificial materials used to create an artificial implant:
- Internal Bracing - Using synthetic tape as a scaffold for the damaged ligament
- Transplant obtained from a deceased donor - The most commonly harvested tissue is the ligament of the patella and the Achilles tendon,
- LARS synthetic prosthesis - It is constructed of nonabsorbable polyester fibers.
ACL reconstruction procedures are definitely more often performed using autogenous grafts. The lower risk of postoperative complications and the high strength of the grafts, as well as the high quality of the procedures performed using grafts made from the patient's own tissue, makes the frequency of these procedures far higher than that of allogeneic grafts.
The duration of surgery is one to two hours, depending on the extent of the damage. For larger injuries, such as meniscus damage, the surgery time may be longer.
Below is a link to an animation showing the reconstruction process:
Are you interested in our article?
The Neuroport team works closely together to achieve the best possible rehabilitation outcome in terms of optimal physical and mental fitness for our patients.
Preparation for Treatment
Preparation for anterior cruciate ligament reconstruction surgery begins well before before the operation itself. It is important that the patient is psychologically ready for the treatment process, which often includes consultation with an orthopedic surgeon and anesthesiologist. The patient should be aware that the operation will be performed under anesthesia, either general or subarachnoid, depending on his condition and preference.
Pre-operative rehabilitation aims to Mute the effects of the injury by reducing symptoms such as pain or swelling and restoring range of motion. According to scientific studies, patients not undergoing specialized rehabilitation, including a preparation period before surgery, are characterized by greater problems in terms of the context of the time in which they were able to regain the range of upright motion in the operated joint joint. It was also noted that in terms of subjective assessment of pain intensity, patients who underwent surgery preparatory procedures experienced less pain, even at a time 12 weeks distant from the surgery. It can therefore be concluded that the effect of this phase of of rehabilitation on postoperative treatments, as well as the time to return to activity, is significant significant.
Patients are also advised to stop taking certain medications, especially those affecting blood clotting to minimize the risk of complications.
Rehabilitation After Treatment
Rehabilitation after anterior cruciate ligament reconstruction is a key part of the of the recovery process. In the first weeks after surgery patient uses crutches elbow, and also, in the case of damage to more structures from the orthosis, to minimize the load on the operated knee. It is important to strictly follow the recommendations physiotherapist, which includes the gradual introduction of muscle strengthening exercises and working on the range of motion of the knee joint.
The total duration of rehabilitation may vary depending on the individual's patient's predisposition and the level of activity they intend to return to, but typically for in the case of athletes lasts from 9 to 12 months. A full return to sports activity is possible only after obtaining adequate muscle strength and stability of the joint knee, which is evaluated based on the results of specialized functional tests.
Risk of Complications After Reconstruction
After knee ligament reconstruction, various complications, which are worth keeping in mind.
Among the most common postoperative complications are the following infections, which manifest themselves redness, swelling and pain in the operated area. In addition, the area of the break skin continuity as a result of the surgery performed may change color and emit an an unpleasant odor. If you suspect a surgical wound infection immediately consult your doctor.
Hematomas are another possible complication, characterized by the accumulation of blood under the skin, which can lead to swelling and pain. In this case, it may be necessary to consult a with a doctor to perform an LP, aimed at evacuating the blood clot that has accumulated in the tissues tissues of the blood clot.
The effect of any post-operative complication can be delayed regeneration, which concerns the The process of tissue healing. Patients may experience prolonged pain, as well as problems with restoring full range of motion and muscle strength. It is important to remember that in ligamentous reconstructions using autogenous grafts, the healing process refers to both the reconstruction site and the site from which the tissue was harvested. It is important to monitor these symptoms and if they occur, consult immediately with your doctor to avoid more serious consequences.
Physiotherapy and Prevention
Physiotherapy plays a key role in the recovery process after ACL joint reconstruction knee. A particularly important aspect for reducing the risk of complications after surgery surgery is proper patient education regarding:
- The ability to put weight on the operated limb,
- to move independently on different types of surfaces,
- ways to minimize the symptoms of surgical treatment, such as pain and swelling,
- dressing care,
- thromboprophylaxis.
Already from the first day After the operation, the patient should start appropriate exercises, which are aimed at increase in range of motion in the knee joint, muscle strengthening and improving the stability of the joint. Recommended exercises include both passive exercises stretching, as well as active exercises to strengthen the quadriceps muscles of the thigh and other muscles that stabilize the knee.
As rehabilitation progresses, more advanced movement patterns and proprioception training are introduced proprioception to help return to daily activities and sports activities.
To avoid future injuries, it is important to continue regular training to strengthen and stabilizing the knee, and use proper training techniques. Constant contact with a qualified physiotherapist is crucial to monitor progress and adjust the rehabilitation plan to meet the patient's individual needs.
Summary
Knee ligament reconstruction is an advanced surgical procedure that is crucial to restoring stability to the knee. Thanks to arthroscopic techniques, the procedure is less invasive, which speeds up the healing process and minimizes the risk of complications.
Rehabilitation before and after surgery is extremely important and for athletes lasts usually 9 to 12 months. Muscle strengthening exercises and working on the range of of movement of the knee joint are crucial for full recovery and sports activity.
The methodology of performing the procedure is selected individually for each patient. The doctor qualifying the patient for the procedure, choosing a specific method takes into account primarily the time that has passed since the injury and the location of the damage within the structure itself.
The risk of complications, such as infections, hematomas or tissue healing problems, exists, but they can be minimized through proper rehabilitation and prompt recognition of undesirable symptoms.
It is very important to make a proper diagnosis supported by a series of tests and consultation with specialists specialists to confirm the damage and the appropriateness, or lack thereof, of surgical intervention surgical intervention.
Bibliography
- Evans J, Mabrouk A, Nielson Jl. Anterior Cruciate Ligament Knee Injury.
- Pardala, T. (2005). A study of knee joint stability after ligament transplantation
Anterior cruciate ligament of the patella proper....
- Pavilan, M., Kalużny, K., Kalużna, A., Hagner, W., & Zukow, W. (2017).
Proceeding's physiotherapy in damage to the anterior cruciate ligament. Journal of
Education, Health and Sport, 7(6), 77-87.
- Vavken, P., & Murray, M. M. (2011). The potential for primary repair of the ACL.
Sports medicine and arthroscopy review, 19(1), 44
- Tulloch, S. J., Devitt, B. M., Porter, T., Hartwig, T., Klemm, H., Hookway, S., & Norsworthy, C. J. (2019). Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy, 27(11), 3626-3632.
- Zaffagnini, S., Grassi, A., Serra, M., & Marcacci, M. (2015). Return to sport after ACL reconstruction: how, when and why? A narrative review of current evidence. Joints, 3(1), 25
- van der Graaff SJA, Meuffels DE, Bierma-Zeinstra SMA, van Es EM, Verhaar JAN, Eggerding V, Reijman M. Why, When, and in Which Patients Nonoperative Treatment of Anterior Cruciate Ligament Injury Fails: An Exploratory Analysis of the COMPARE Trial. Am J Sports Med. 2022 Mar
- Giesche F, Niederer D, Banzer W, Vogt L. Evidence for the effects of prehabilitation before ACL-reconstruction on return to sports-related and self-reported knee function: A systematic review. PLoS One. 2020 Oct
- Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Grossmann I, Sange I. Anterior Cruciate Ligament Injury: Conservative Versus Surgical Treatment. Cureus. 2021 Dec.
- Kiminari Kataoka, Yuichi Hoshino, Koji Nukuto, Anterior cruciate ligament reconstruction: recent evolution and technical improvement, Journal of Joint Surgery and Research, Volume 1, Issue 1, 2023
