Ligaments are bands of tough, elastic connective tissue that surround a joint to give support and limit the joint's movement.
When ligaments are damaged, the knee joint may become unstable. Ligament damage often happens from a sports injury. A torn ligament severely limits knee movement. This results in the inability to pivot, turn, or twist the leg. Surgery is a choice to repair a torn ligament if other medical treatment is not effective.
There are 4 major ligaments in the knee. The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:
- Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).
- Posterior cruciate ligament (PCL). The ligament, located in the center of the knee, that controls backward movement of the tibia (shin bone).
- Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.
- Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.
The anterior cruciate ligament (ACL) is located toward the front of the knee. It is the most common ligament to be injured. The ACL is often stretched and/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 posterior cruciate ligament (PCL) is located toward the back of the knee. It is also a common knee ligament to be injured. However, the PCL injury usually happens with sudden, direct impact, such as in a car accident or during a football tackle.
The medial collateral ligament (MCL) is located on the inner side of the knee. It is injured more often than the lateral collateral ligament (LCL), which is on the outer side of the knee. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.
Early medical treatment for knee ligament injury may include:
- Ice pack application (to reduce swelling that happens within hours of the injury)
- Compression (from an elastic bandage or brace)
- Pain relievers
A knee ligament tear may be treated with the following:
- Muscle-strengthening exercises
- Protective knee brace (for use during exercise)
- Activity limitations
Knee ligament repair is a treatment for a complete tear of a knee ligament that results in instability in the knee. People with a torn knee ligament may be unable to do normal activities that involve twisting or turning at the knee. The knee may buckle or “give-way.” If medical treatments are not satisfactory, ligament repair surgery may be an effective treatment.
The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft) or from an organ donor (allograft).
There may be other reasons for your healthcare provider to recommend a knee ligament repair.
As with any surgical procedure, complications can happen. Some possible complications may include the following:
- Blood clots in the legs or lungs
Some people may experience pain, limited range of motion in the knee joint, and occasional swelling in the knee after surgical ligament repair. Others have increased motion in the knee joint as the graft stretches over time.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
- Your healthcare provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your healthcare provider may perform a complete physical exam to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
- Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
- If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider.
- You will be asked to fast for 8 hours before the procedure, generally after midnight.
- You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for some to drive you home.
- You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
- Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
- Based on your medical condition, your healthcare provider may request other specific preparation.
Knee ligament repair may be performed on an outpatient basis or rarely as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.
Knee ligament repair may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your healthcare provider will discuss this with you in advance.
Generally, knee ligament repair surgery follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- An intravenous (IV) line may be started in your arm or hand.
- You will be positioned on the operating table.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The healthcare provider will make several small incisions in the knee area.
- The healthcare provider will perform the surgery using an arthroscope (a small tube-shaped instrument that is inserted into a joint). The healthcare provider may reattach the torn ligament or reconstruct the torn ligament by using a portion (graft) of the patellar tendon (that connects the kneecap to the tibia), the hamstring tendon (from the back of the thigh), or other autografts. The tendon graft may come from the person (autograft) or from an organ donor (allograft).
- The healthcare provider will drill small holes in the tibia and femur where the torn ligament was attached.
- The healthcare provider will thread the graft through the holes and attach it with surgical staples, screws, or other means. Bone eventually grows around the graft.
- The incision will be closed with stitches or surgical staples.
- A sterile bandage or dressing will be applied.
After the surgery you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Knee ligament repair is usually done on an outpatient basis.
You may be given crutches and a knee immobilizer before you go home.
Once you are home, it is important to keep the surgical area clean and dry. Your healthcare provider will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
To help reduce swelling, you may be asked to elevate your leg and apply an ice bag to the knee several times per day for the first few days. Your healthcare provider will arrange for an exercise program to help you regain muscle strength, stability, and range of motion.
Notify your healthcare provider to report any of the following:
- Fever or chills
- Redness, swelling, bleeding, or other drainage from the incision site
- Increased pain around the incision site
You may resume your normal diet unless your healthcare provider advises you differently.
Because of the limited mobility, it may be difficult for a few weeks to resume your normal daily activities. You may need someone at home to assist you. You should not drive until your healthcare provider tells you to. Other activity restrictions may apply. Full recovery from the surgery and rehabilitation may take several months.
Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Anterior Cruciate Ligament Injury. UpToDate
Joseph, Thomas N., MD,Moloney Johns, Amanda, PA-C, MPAS, BBA