Cruciate Knee Ligament Surgery

There are two cruciate ligaments in the knee: the anterior in the front, and the posterior in the back. Together the cruciate ligaments maintain the stability of the knee in conjunction with the other ligaments and muscles and the menisci. Injuries to the anterior cruciate ligament, or ACL, are more common than injuries to the posterior cruciate ligament, or PCL. A sports accident is the typical culprit behind an ACL injury. Twisting or locking the knee, or forcing a bent knee in the direction opposite its normal movement, can cause lesions to the cruciate ligament. Less commonly, that can tear the ligament completely.

Considerations

• Cruciate ligament injuries do not always warrant surgery. Factors such as your age, job, activity level and severity of pain from the injury will determine whether you'll need surgery. Physical therapy might be enough to strengthen and rehabilitate your knee, rendering complex surgery unnecessary.

Surgery

• You'll probably go under general anesthesia for the surgery. The surgeon will perform an arthroscopy, which involves inserting a scope into a joint to check for damage. If there's any further damage to the joint, the surgeon will try to repair it. If the ligament became detached, the surgeon will reattach it.

  If the ligament tore, the surgeon will perform an autograft. He will construct a new cruciate ligament for you out of the patella tendon or out of two hamstring tendons. Less commonly, the surgeon might use a tendon from a cadaver. This is called an allograft. This is not living tissue, so your body is unlikely to reject the tendon. He will place the new tendon into your new joint so it takes the shape of the original ligament.

Recovery

• You should be able to walk on crutches by the day after the surgery. You'll usually need crutches for about two weeks, and you'll need your doctor's permission to get off the crutches. You might have to wear a hinged splint while your knee recovers. You can expect some ugly bruising and swelling to last for a few weeks following surgery.

  A burning sensation is also normal--this comes from the surgeon drilling into your bones to insert the new tendon in place. Your doctor will prescribe pain medications to help alleviate the pain, and icing your knee will also help.

Rehabilitation

• A physical therapy regimen is crucial to full recovery, and it probably begin to some extent within a few weeks after surgery. At least three months of rehabilitation will be necessary. If you're an athlete, you'll probably need at least six months before you can make a full return to your sport. The more you work at the exercises and stretches your physical therapist shows you, the sooner and more completely your range of motion should return.

Long-Term Effects

• It's normal to feel some stiffness and popping even after you've completed your rehabilitation program. It's probably scar tissue. After surgery, it can take some time for you to be able to kneel. If you are an athlete, your doctor or physical therapist might advise you to wear a knee brace while you play.