The anterior and posterior cruciate ligaments are the key knee stabilizers. Having  An anterior cruciate ligament (ACL) injury is one of the most common sports injuries. Here's everything you need to know about Knee ligament surgery.

What is Knee Ligament Surgery?

ACL surgery is a procedure that replaces a torn ligament with other tissue, often harvested from the patient's own body. The surgeon removes the damaged ligament and replaces it with a piece of tendon, which is a connective tissue that links muscles to bones. (1)

Ligament tears are commonly associated with sports injuries, particularly in activities that involve sudden stops or rapid changes in direction, like football and basketball. They can also result from accidents, such as car crashes or falls, and may be exacerbated by ligament weakness that comes with aging. (2)

Indications

This surgery is typically performed if you have a ligament tear accompanied by: (3)

• Knee instability, particularly during sudden movements or changes in direction.
• A "clicking" or "popping" sensation in the knee.
• Persistent pain despite undergoing physical therapy and other non-surgical treatments.

The decision to undergo surgery depends on factors like age, activity level, severity of the injury, and impact on daily life. Athletes and active young people often require surgery to return to their previous activity levels, while older adults may prefer other treatments to manage symptoms. (3)

Results

Knee ligament surgery can reduce pain and restore most knee functions in more than 80% of cases. However, some residual pain and swelling may persist, often due to other injuries sustained at the same time. (4)

Risks

While knee ligament surgery is generally safe and successful, it does come with potential risks and complications. Although uncommon, you should be aware of them before undergoing surgery: (1)

• Bleeding
• Infection
• Chronic pain
• Weakness or stiffness of the knee, or loss of range of motion
• Blood clot in the leg
• Damage to nerves and blood vessels around the knee
• Failure of the new ligament to heal properly
• Failure of the surgery to relieve symptoms

There are also the risks associated with anesthesia, such as drug allergies and breathing problems. (1)

Preparation

To achieve the best outcomes and maximize recovery after surgery, it’s important to prepare your knee by: (4)

• Allowing swelling to subside.
• Restoring as much movement as possible before surgery (usually around 3 weeks after the injury, though this can vary).
• Strengthening your thigh muscles as much as possible.

Your doctor may recommend simple exercises to improve the flexibility of your knee, such as swimming. You’ll also undergo medical tests, such as blood and imaging tests, and may be advised to stop certain medications or supplements and to fast for several hours before surgery. Be sure to arrange transportation home after surgery. (1)

Surgery Steps

The surgery usually lasts between 1-1.5 hours, (5) and is performed under general or spinal anesthesia. 

During the procedure: (1)(6)

• The surgeon makes one or more small incisions in the knee.
• Arthroscopy, a minimally invasive surgical technique, is often used to view the inside of the knee with a camera.
• The surgeon removes the damaged ligament and uses a segment of another tendon in your body to construct a new ligament, securing it with screws or special fixators.

Recovery

Here is what you need to know: (4)(5)

Initial Period: You will likely be able to return home on the same day or the following day, and you will use crutches and a leg brace on the day of the surgery. Rehabilitation and physical therapy will start as soon as possible according to your doctor’s instructions, with special exercises to strengthen your knee muscles and improve motion.

Returning to Daily Activities Gradually, you’ll be able to resume daily activities such as walking, climbing stairs, and light housework, depending on the severity of your injury and your progress in physical therapy.

Returning to Sports Full recovery and return to sports may take about 6 months or more, depending on the sport and the severity of the injury. Your return should be guided by your doctor and physical therapist. 

Important Points After Surgery:

• Follow your doctor’s treatment plan, including physical therapy, exercises, and medications.
• Wear your knee brace to protect your knee.
• Elevate your leg to reduce swelling.
• Keep follow-up appointments with your doctor to monitor your progress.

Schedule your appointment today at the Orthopedics and Joints Department at Dr. Soliman Fakeeh Hospital. We provide comprehensive care, from surgery to rehabilitation, to help you recover quickly and get back to your everyday life and favorite sports.

References

1. ACL reconstruction, MedlinePlus Medical Encyclopedia
2. Anterior Cruciate Ligament (ACL) Injuries, OrthoInfo - AAOS
3. Anterior Cruciate Ligament (ACL) Reconstruction, Physiopedia
4. Knee ligament surgery, NHS
5. ACL reconstruction, healthdirect‍
6. ACL Reconstruction Animation, OrthoInfo - AAOS