Knee Ligament Reconstruction: Procedure, Recovery, Cost, Risk & Complication

Knee ligament reconstruction is a surgery that is performed for replacing an anterior cruciate ligament (ACL) that may have been damaged or torn. ACL is one of the main ligaments of the knee. This tough tissue band joins the thigh bone with the shin bone at your knee joint. The ligament provides stability to the knee joint and also controls the back and forth movement of your lower legs. An injury in the ACL tends to occur most commonly during sport activities like football, tennis, basketball, soccer, gymnastics, etc, which involves stopping abruptly or changing directions.

In a knee ligament construction surgery, the affected ligament needs to be removed and replaced with a tendon from your other knee or from a deceased donor. It is performed by making small incisions around the knee joint.

A knee ligament reconstruction is recommended in the following cases:

• You are a professional athlete and you want to continue playing your sport, especially if it involves cutting, jumping or pivoting
• You are young and very active, not wanting any discomfort in movement
• If more than one ligament or else the knee’s cartilage has been injured
• The injury results in your knee to buckle in the course of your regular daily activities
• If the injury is affecting your quality of life

Pre Procedure

You need to take certain pre-procedure preparations that you need to take before the surgery:

• There is a possibility that you may have to undergo several weeks of physical therapy before surgery. The reason why it is recommended is for reducing the pain and swelling of the knee, restoring the complete range of motion of your knees as well as strengthening the muscles. If you undergo a surgery with a swollen or stiff knee, the healing process will not be smooth and sometimes the full motion of the knees is also not regained.
• Your doctor must be informed about the list of medicines, herbal medications if any, and dietary supplements that you take on a regular basis. Blood thinning medicines may have to temporarily discontinued as it may increase the risk of bleeding during the surgery.
• Follow the doctor’s instructions about when should you stop eating or drinking hours before the surgery.

During Procedure

In most of the cases, general anaesthesia is used during the surgery, keeping you unconscious during the whole procedure. Small incisions are made; one is used for holding the arthroscope while the other cuts allow the surgical instruments to get access to the joint area of the knee.

The surgeon then removes the torn ligament, and replaces it with a tendon segment. A tendon is a tissue that is similar to a ligament, connecting the muscles to the bone. The replacement tissue is known as a graft. The tendon is generally taken from your other knee or a deceased donor. Sockets are then drilled into both the thigh bone and shin bone, so that the graft can be positioned accurately and then secured with fixation devices. This graft acts as scaffolding on which a new ligament tissue possibly grows.

Post Procedure

Once you have recovered from the effects of anaesthesia, you will be able to go home on the same day. Wearing a splint or knee brace may is often recommended for protecting the graft that has been made. You can also practice walking with the help of crutches before you leave the hospital.

Follow the instructions regarding shower, bath and changing of the dressing given by the doctors. Adequate rest is important for a faster recovery. You can also apply ice in your knee after every 2 hours for duration of 20 minutes. A compression wrap around the knee can also prove to be beneficial. Also, lie down with the knees propped up on your pillows.

Physical therapy after the surgery will help in strengthening the muscles around your knees as well as improve flexibility. A physical therapist can help you with it.

Healing of the ligaments can be aided by some of the techniques which are based on the fact of maintaining an adequate flow of blood in the injured region. Some of them are such as:

• Use of icing on a short-term basis.
• Application of heat to the specific region.
• Doing a proper movement of the affected area.
• Adequate hydration.
• Application of technologies related to sports medicine, such as Graston technique and NormaTec recovery.

Following the ACL reconstruction surgery, there are things that need to be done to assure a proper and complete recovery while taking some important precautions too.

1. Do’s:
   • Upward and downward movement of ankles.
   • Elevation of the leg at an angle of 45 degrees.
   • Intake of medicines such as ibuprofen for pain.
   • Slow bending exercise of the knee.
   • Continuous monitoring of the fever should be done.
   • Sterile dressings are advised to be done to ensure the cleaning and drying of the wound.
   • Rehabilitation.
2. Don'ts:
   • Swimming should be avoided for up to 5 months.
   • Running should also not be done.
   • Quadriceps muscles should not be used for workouts.

The chances of the surgery that you have undergone to be a success depend on your age, general health condition and the proficiency of your doctors. There can be certain risks too that come with every surgical procedure. The risks or complications that may occur in a knee replacement surgery are:

• Bleeding or infection, which may occur in any surgical procedure
• Formation of blood clots
• Knee pain that is likely to occur if a patellar tendon has been used by the surgeon as a graft tissue, causing pain behind the kneecap or when you are kneeling or crouching
• If the graft heals in a poor manner
• Stiffness or weakness in the affected knee
• In extremely rare cases, the ligament that has been grafted may fail, causing your knee to remain unstable

Tearing of anterior cruciate ligament due to several leg injuries is followed by Knee Ligament Surgery. The overall recovery usually takes up to one year. Stitches are done for closure of the wound after the surgery which takes approximately 3 weeks to get dissolved. During this time, the wound needs to be cared for by following proper hygiene instructions under the supervision of a surgeon.

Follow the rehabilitation programme advised by your doctor for a faster recovery. Continue doing the exercises like bending, straightening and raising your leg. With time, these exercises can be increased or changed. After a few weeks, you may resume exercises like swimming or cycling, but refrain from activities that involve too much of twisting or jumping. A professional athlete can get back to sports after 8-12 months, providing enough time to the graft tissue to position itself securely in the knee. You will be able to resume driving in 2-3 weeks, depending on your condition. If your work involves going to an office, you can resume work in 2-3 weeks. If your profession involves manual labour, it may take you up to 3 months before you are able to return to work.

The cost of knee replacement surgery would be approximately Rs. 75,000 – Rs. 1,50,000.