Knee Ligament Reconstruction: Specialists & Treatment Information

There are various ligaments in and around the knee joint that stabilize it:

• the posterior and anterior cruciate ligaments, as well as
• the medial and lateral collateral ligaments.

The collateral ligaments prevent the joint from giving way to the side while ensuring stable movement of the knee. The medial collateral ligament also connects to the medial meniscus and the joint capsule.

Sports injuries, in particular, are a common cause of torn ligaments in the knee. Sudden, jerky movements—such as those that occur in soccer or squash—carry a higher risk of this happening. If one of the collateral ligaments tears, it negatively affects the stability of the knee. Therefore, such a ligament tear should be treated as soon as possible.

When conventional methods are no longer effective, surgical intervention is necessary. When a torn ligament in the knee is replaced with the body’s own tendons, doctors refer to this as knee ligament reconstruction.

Knee ligament reconstruction is typically performed by

• surgeons,
• knee surgeons,
• orthopedic surgeons, or
• trauma surgeons

are involved.

As part of the diagnostic process, the orthopedic surgeon or surgeon usually consults a radiologist. The radiologist often performs a magnetic resonance imaging (MRI) scan. Unlike an X-ray, an MRI also shows soft tissues such as ligaments and cartilage.

Using this imaging technique, the radiologist can accurately assess the extent of the damage to the knee joint.

Treatment for ligament injuries often begins with conservative measures, that is, with

• medication,
• rest, and
• physical therapy.

If these approaches do not help, the joint must be stabilized by other means. This is usually done with knee ligament reconstruction.

Partial tears are rare, especially in the medial collateral ligament. It usually tears completely, allowing the knee to give way significantly inward or outward. The bone to which the ligament is attached is also frequently affected by such injuries.

A simple knee ligament suture is not sufficient in this case. Instead, during knee surgery, the surgeon replaces the damaged ligament structure with the patient’s own tendon tissue.

The following factors indicate the need for knee ligament reconstruction:

• The knee joint exhibits significant instability.
• The knee injury is complex.
• The patient is still young.
• The patient’s knees are subjected to heavy strain in daily life (sports, work).

Knee ligament reconstruction is performed under general anesthesia and—if possible—using arthroscopy. Arthroscopy is a minimally invasive procedure (“keyhole surgery”) used to examine and treat damage to the knee joint. The surgeon makes only a very small incision through which a thin camera and the necessary surgical instruments are inserted.

However, in cases of extensive injuries, the surrounding tissue and/or bone structures are often affected as well. In such cases, a larger incision is necessary.

First, the surgeon needs a tendon suitable for knee ligament reconstruction. Replacement with synthetic material is very rare. The surgeon usually harvests the tendon directly from the patient’s own body. To do this, at the beginning of the procedure, the surgeon makes a small incision at a predetermined site.

Various ligaments of the thigh are particularly well-suited for knee ligament reconstruction.

In the next step, the surgeon integrates the harvested tendon into the ligamentous apparatus of the knee joint. In the case of a medial collateral ligament tear, the surgeon usually replaces only the posterior portion of the tendon due to the complex branching of the ligament. This is generally sufficient to adequately stabilize the knee.

If further procedures are necessary—such as screwing loose bone fragments together—these are performed at the same time.

In some cases, multiple procedures are necessary. The surgeon first examines the joint using arthroscopy and removes any remaining fragments of the damaged ligament. If the meniscus is torn, it is sutured back in place or partially removed.

The patient then undergoes several weeks of physical therapy to strengthen the muscles and reduce swelling. Only then is the knee ligament reconstruction performed during a subsequent arthroscopy.

Knee ligament reconstruction is a state-of-the-art surgical procedure. It has proven effective and is routinely performed in orthopedic and trauma surgery clinics. The prognosis for knee ligament reconstruction is therefore very good.

However, the healing process takes several weeks or even months.

After surgery, it is extremely important to strengthen the leg muscles to further stabilize and strengthen the knee joint. Knee ligament reconstruction is therefore usually followed by several weeks of rehabilitation. This can be done on an outpatient or inpatient basis.

This is followed by further physical therapy measures. These include targeted exercises for muscle building as well as coordination training. These measures help the patient avoid or compensate for unfavorable movements. In addition, the patient learns to compensate for any deficits that may have arisen due to the loss of the original ligament.

It usually takes about a year before the patient can participate in sports without restriction. However, lighter physical activities are possible after just a few months, provided the doctor gives his or her approval.

As with any surgical procedure, complications can also arise with knee ligament reconstruction. For example, there is a risk of damaging surrounding structures (nerves, blood vessels) during the operation.

In rare cases, inflammation of the wound or the knee joint itself may occur after the procedure. A ligament injury also increases the risk of joint wear (osteoarthritis).

Professional care is essential for injuries to the ligaments in the knee. Only prompt and expert treatment can fully and permanently restore the stability of the knee joint.

The right person to consult for personalized treatment of knee and ligament injuries is a specialist in knee ligament reconstruction. Such specialists work in many orthopedic or surgical clinics.