Ligament reconstruction

Medically reviewed by Sam Rajaratnam FRCS (Tr. & Ortho).

Injuries to the Ligaments of the Knee

The knee is a complex hinge joint . The ligaments around and within the knee hold the joint together and prevent it from giving way during twisting and turning activities.

Various sporting injuries can damage the ligaments around the knee.  

The most important ligamentous injuries include trauma to the following:

• the medial collateral ligament  (MCL)
• the anterior cruciate ligament (ACL)
• the posterior cruciate ligament (PCL)
• the lateral collateral ligament (LCL)
• the medial patellofemoral ligament (MPL)

Knee injuries may often affect any combination of ligament, cartilage or structure, so an early assessment on the acutely injured knee is vital.

If you have injured one of the ligaments around your knee, you will need an urgent clinical assessment and appropriate X-rays and MRI scans.

The earlier the diagnosis, the more effective the treatment.

The important procedures in the treatment of knee ligament injuries are early diagnosis, speedy repair of damaged structures, and prevention of further damage due to ongoing instability.

Once a diagnosis is made, you may require physiotherapy, bracing, protected weight-bearing and occasionally surgery.

Many injuries can be treated without surgery if diagnosed early.

Anterior Cruciate Ligament Reconstruction (ACL)

The anterior cruciate ligament is an important stabiliser of the knee joint.

It prevents the knee from giving way when you pivot and change direction during activity.

ACL reconstructions have been performed for the last 30 years, and significant advances in surgical techniques have been made during this time.

It is now usually done using keyhole surgery (rather than a large incision) and a variety of different graft material can be used. The most popular method of reconstructing an anterior cruciate ligament currently is the use of hamstring tendon, although alternatives include patella tendon, allograft tissue or artificial material (LARS ligament).

if you need an ACL reconstruction, Mr.Rajaratnam prefers to use the patient’s own hamstring tendons , as these give excellent and reliable results , but he will talk you through the various options available and their merits.

What to expect from your ACL reconstruction

Mr. Rajaratnam strongly believes in rapid recovery programmes following ACL reconstructions, and has developed a number of these protocols in the hospitals in which he operates.

Following ACL reconstruction, and a full course of rehabilitation, most patients will return to full sporting activity with a strong, stable and pain-free knee

A long period of physiotherapy and recovery is required after ACL reconstruction, and it normally takes 9 months before the patient can return to full contact sports.

PCL (posterior cruciate ligament) reconstruction

The posterior cruciate ligament is an important ligament at the back of your knee.

You can injure your posterior cruciate ligament if your knee sustains a head-on blow (for example in a motorbike accident or a rugby injury).

A PCL injury may be treated with bracing and physiotherapy in a number of instances, but occasionally a grade 2 or grade 3 PCL injury may need a surgical reconstruction.

What to expect from your PCL reconstruction

Mr. Rajaratnam does PCL reconstructions with the keyhole technique, and often uses the patient’s hamstring tendons or allograft material to reconstruct the PCL.

Like an ACL reconstruction, and PCL reconstruction will need an extensive physiotherapy programme to return the patient to peak fitness.

Medial Collateral Ligament injuries (MCL)

Most isolated MCL injuries can be treated conservatively with bracing and physiotherapy, as the vast majority heal very well without surgery.  

It is therefore important to diagnose these as early as possible after the injury occurs.

MCL injuries can also occur in combination with meniscal tears and ACL injuries, which will need careful management.  Mr.Rajaratnam will carefully guide you through the appropriate surgical and rehabilitation programme to enable optimal recovery for any combination of injury.