Description

Knee Ligament Surgery – ACL Reconstruction

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 knee ligament surgery 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.