Knee ligament surgery is a reconstructive procedure that can be required due to tearing the anterior cruciate ligament (ACL) in the knee. The ACL is the band of tissue at the knee joint which connects the shin bone to the thigh bone. It provides structure and helps to control the movement in the lower leg. Knee ligament damage can severely affect the stability of the knee, affecting range of movement in the leg. Depending on the severity of ACL damage, it can impact on a patient’s quality of life and require surgery.
ACL injuries are commonly a result of sporting accidents, often from football, rugby, skiing and tennis. The knee ligament can be damaged from over-extending the lower leg or if the knee and lower leg are twisted. These injuries account for 40% of sporting accidents, typically as a result of having a collision, landing incorrectly, and stopping or changing direction suddenly.
The decision to have surgery on an ACL injury should be carefully considered and based on the extent of the damage and the effect it has on the patient’s life. For the less active person, the risks of surgery may outweigh the potential benefits. However, it is important to make the decision quickly, as delaying surgery may cause further damage to the knee ligament.
The period between injury and ACL surgery is likely to be at least three weeks, as outcome results are optimised and recovery time is shortened by having the full range of movement in the knee. Patients are sometimes referred to a physiotherapist so that stretches can help keep the leg flexible. Low impact exercise such as swimming or cycling can also improve muscle strength without putting excess pressure on the knee.
An arthroscopy is a form of keyhole surgery which can assess the damage to the ACL. Keyhole surgery uses very small equipment which creates a smaller wound, causing less pain, minimising the risk of infection and reducing recovery time. In several Ali Ghoz publications, leading consultant trauma and orthopaedic surgeon Professor Ali Ghoz discusses this type of knee and hip surgery. His innovative work is at the forefront of using computer-aided techniques in ACL surgery.
A common method of reconstructing a damaged ACL is to replace the ligament with a tendon from elsewhere in the body. Several different types of tissue can be used to replace the ACL, such as a strip of patellar tendon (the tendon running between the kneecap and shin bone) or part of the hamstring tendon (which runs from the back of the knee up the thigh). Modern keyhole surgeries mean that it is often possible for patients to return to light physical activity within a few weeks.