Multi-Ligament Repair

Knee ligament injuries are graded based on the severity of injury. In grade I, the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II there is a partial tear of the ligament. In grade III there is a complete tear of the ligament and the ligament is divided into two halves making the knee joint unstable. If the overall stability of the knee is intact, your doctor will recommend non-surgical methods including medications, physical therapy, the use or rest and ice therapy and bracing.  If surgery is required, a ligament repair may be performed, with or without reconstruction with a tendon graft; depending on the location and severity of the injury. The surgical repair of the completely torn ligament involves reconstruction of the torn ligament using a tissue graft taken from another part of the body, or from a donor. The damaged ligament is replaced by the graft and fixed to the femur and tibia using metallic screws. Gradually, over a period of a few months, the graft heals. 

Surgical reconstruction is typically accomplished arthroscopically and can be performed on any of the ligaments in the knee.  Most common is the repair of the ACL or anterior cruciate ligament. Anterior cruciate ligament (ACL) reconstruction hamstring method is a surgical procedure that replaces the injured ACL with a hamstring tendon. The procedure is performed under general anesthesia. Once taken to the operating room, anesthetized, and properly positioned; your surgeon will make two small cuts about 1/4 inch long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint. The knee is bent at right angles and the hamstring tendons felt. A small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared. The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.

Arthroscopic knee reconstruction can take as little as 1 hour to over 3 hours dependent upon the extent and complexity of the injury. Most patients are discharged the same day after knee arthroscopy. Recovery after the surgery depends on the type of repair procedure performed. Recovery from knee arthroscopy is much faster than that from an open knee surgery.  Pain medicines are prescribed to manage pain. Crutches or a knee brace may be recommended for several weeks.   Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint. Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting.