Having Your Cruciate Ligament Reconstructed
When you rupture your cruciate ligament it is immediately obvious there is a problem, apart from the “pop” sound or feeling as the structure fails. The knee is painful at once and swells up very rapidly, making diagnosis difficult in the emergency department, the definitive diagnosis perhaps being delayed by several weeks. Once the rupture is diagnosed the surgeon will very likely send you to physiotherapy for rehabilitation. Rehab of the knee is very important before the operation and prepares you for what you will need to do afterwards as well as restoring the knee to close to normal function.
Once the knee has settled and you have good muscular control the surgeon will consider the reconstruction which often needs to be done if the knee is to function normally and not deteriorate over time and become arthritic. Reconstruction of the ligament means that some of your tissue needs to be taken to substitute for the lost ligament and fixed through tunnels drilled in the bone so that it is positioned as close as possible to the original structure.
The two most common surgical techniques are the bone-tendon-bone and the hamstring tendon techniques. In the first a piece of the patella, the tendon below it and the tibial tuberosity (bump at the front below the knee) are removed to act as the new ligament. In general this works well but there have been reports of patellar pain and even fracture. The other technique is to harvest the tendons of the hamstrings or gracilis muscle and use them, although two stranded repairs have been shown to stretch some many surgeons now use four strands.
The technique is usually done arthroscopically and in some cases the patient can go home later the same day as long as they report for physiotherapy at the soonest opportunity to begin the rehabilitation process. The physiotherapist will guide you in re-establishing the control of your quads muscles, keeping your patella mobile, increasing your range of knee flexion and in weight bearing for walking. Restoration of knee movement, strength and the ability to walk is surprisingly rapid with most people doing without crutches very quickly and certainly by two weeks.
Rehabilitation under the supervision of a physiotherapist will continue typically for some months. The physio will concentrate on knee power, full range of both flexion and extension, normal gait, balance and coordination and the restoration of good joint position sense.
Author: Jonathan Blood-Smyth