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The
anterior cruciate ligament is an important ligament
inside the knee joint. It can be damaged during sporting
activities such as football, rugby, skiing, etc. If
it ruptures, it cannot heal itself. Most people, especially
active people, will develop an unstable knee. They often
feel the knee “giving way” during pivoting movements
and the knee will swell up.
An
unstable knee might need an operation to reconstruct
the torn ligament. The surgeon will take a tendon from
the thigh (“hamstring tendons”) or from below the knee
cap (“patella tendon”) and put it into the knee and
fix it with screws to the thigh and shin bone. This
is done arthroscopically (keyhole surgery) and often
as a day case procedure.
Afterwards,
the patient must adhere to a strict physiotherapy program
to strengthen the muscles around the knee joint.
The success rate is approximately 80% and most patients can return to their pre-injury activity level and participate in sports six to twelve months after surgery.
Complications after anterior cruciate ligament reconstruction (overall 6%):
- Pain, swelling and stiffness: The knee joint will be moderately painfull and stiff in the days after the operation. Adequate anti-inflammatory medication and aggressive physiotherapy will overcome this. The earlier a patient regains full range of motion, the better the function outcome will be. Inappropriate placement of the new ligament within the knee joint can also result in stiffness usually lack of full extension.
- Graft elongation and rupture (5%): It will take about three month for the new ligament to heal and up to twelve months for it to function properly. During that time, the graft can stretch out or even tear if the patient does not follow the rehabilitation protocol devised by the surgeon and physiotherapist. Both can result in an unstable knee.
- Infection (1%): This is rare after arthroscopic surgery and can necessitate further surgery.
- Nerve injury: There might be some permanent numbness around the knee especially along the inside of the thigh where the hamstring tendons were harvested.
- Anterior knee pain: A small number of patients will experience this complication, which is usually mild in nature and less common with modern surgical techniques.
- Knee Arthritis: Anterior cruciate ligament reconstruction does not reduce the risk of developing wear and tear in the knee joint later in life
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