Knee Ligament surgery (ACL – PCL – MCL – LCL)

What is a Knee Ligament?

A ligament is a short band of tough fibrous connective tissue composed mainly of long, stringy collagen molecules. Ligaments connect bones to other bones in and around joints. They do not connect muscles to bones; that is the function of tendons. Ligaments limit the amount of mobility of a joint, or prevent certain movements altogether.

Major Knee Ligaments

  1. Anterior cruciate ligament(ACL)
  2. Posterior cruciate ligament (PCL)
  3. Medial collateral ligament (MCL)
  4. Lateral collateral ligament (LCL)

Causes and Risk factors of Ligaments Injury

1) anterior cruciate ligament(ACL):  ACL injury is usually a sports-related knee injury. About 80% of sports-related ACL tears are “non-contact” injuries.

  • Suddenly slowing down and changing direction (cutting)
  • Pivoting with your foot firmly planted
  • Landing awkwardly from a jump
  • Stopping suddenly
  • Receiving a direct blow to the knee or collision, such as a football tackle

Female athletes are known to have a higher risk of an ACL tear while participating in competitive sports. Unfortunately, still it is not clear that why women more prone to develop ACL injury.

2) Posterior cruciate ligament (PCL): The main cause of PCL injury is severe trauma to the knee joint. Often, other ligaments in the knee are affected as well. One cause specific to PCL injury is hyperextension of the knee. This can occur during athletic movements like jumping.

3) Medial collateral ligament (MCL):Most medial collateral ligament tears happen during athletic activity, such as when someone: changes direction or twists the knee while running and jumps and lands in a way that twists the knee.
MCL  also can tear if the knee is hit forcefully from the side.

 4) Lateral collateral ligament (LCL): LCL is injured when the varus force is too great for the ligament to resist and the ligament is overstretched. This can occur through a sharp change in direction, twisting the knee whilst the foot is fixed, incorrect landing technique, hyperextension of the knee or a blunt force hit to the knee, such as in football tackle or a motor vehicle accident.

Symptoms and Severity of Knee Ligaments Injury

Grade I sprain(Mild) : ligaments may stretch, but they don’t actually tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury.

Grade II sprain(Moderate) the knee ligament tears partially. Swelling and bruising are common, and the use of the joint is usually painful and difficult.

 Grade III sprain(Severe) : ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight.  Often there will be no pain following a grade III tear as all of the pain fibers are torn at the time of injury.

Diagnosis of Ligaments Injury

  1. Medical history :orthopedic surgeon will gather information about your general health and ask questions about the extent of your knee pain and how it affects your ability to perform everyday activities.
  2. Physical examination: This will assess knee mobility, strength, and alignment.
  3. Blood tests: It is also helpful the evaluation of the condition such as arthritis.
  4. X-rays: Which help to determine the extent of damage or deformity in your knee.
  5. MRI(magnetic resonance imaging ): It may be needed to determine the condition of the bone and soft tissues and ligaments  of your knee joint.

Surgery of Knee Ligaments

1) ACL reconstruction surgery: ACL reconstruction surgery uses a graft  to replace the ligament. The most common grafts are autografts using part of your own body, such as the tendon of kneecap(patellar tendon)or one of the hamstring tendon. Sometimes the quadriceps tendon from above the kneecap is used. Another choice is allograft tissue, which is taken from a deceased donor.

2) PCL reconstruction surgery:Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee. Crutches may be recommended to protect your knee and avoid bearing weight on your leg.

Surgery is considered in patients with a dislocated knee and multiple ligament injuries, including the PCL. Surgery involves reconstruction of the torn ligament using a tissue graft taken from another part of the body, or from a donor.

3) MCL reconstruction surgery:A nonsurgical treatment plan will include some or all of the following:

  1. Applying ice to reduce swelling
  2. Taking anti-inflammatory medication to reduce pain and swelling
  3. Using an elastic bandage or brace to compress the knee
  4. Walking with crutches to keep the weight off the injured knee
  5. Limiting activities that could cause reinjury or disrupt healing
  6. Physical therapy to regain strength

During MCL surgery, the orthopedic surgeon will make small incisions in your knee and insert an arthroscope, which is a small tube-shaped instrument. Methods for reattaching or reconstructing the torn ligament can vary. Options include using a portion of the patellar tendon (which connects the tibia and the kneecap) or the hamstring tendon (from the back of the thigh). Tendon grafts can come from the patient or an organ donor.

4) LCL reconstruction surgery:

A nonsurgical treatment plan will include some or all of the following:

  1. Applying ice to reduce swelling
  2. Taking anti-inflammatory medication to reduce pain and swelling
  3. Using an elastic bandage or brace to compress the knee
  4. Walking with crutches to keep the weight off the injured knee
  5. Limiting activities that could cause reinjury or disrupt healing
  6. Physical therapy to regain strength

Surgery may be considered if there is significant ligament disruption eg Grade III. Knee surgery may also be required if there is a significant combination of injuries involving the ACL, posterolateral corner and/or meniscus.

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