Arthroscopic Reconstruction of the Knee for Ligament Injuries

The knee is one of the most complex joints in the body and is formed by the articulation between the thigh bone (femur) and the shinbone (tibia). A knee cap (patella) is present over the front of the joint to provide extra protection and to improve the mechanical advantage of the thigh muscles. The femur and tibia are held together by four strong ‘rope-like’ structures called ligaments. Two collateral ligaments are present on either side of the knee and control the sideway movement of the knee. The other two ligaments are the anterior and posterior cruciate ligaments, ACL and PCL respectively, which are present in the centre of the knee joint and cross each other to form an ‘X’. The cruciate ligaments control the back and forth movement of the knee and have some control over rotation of the knee.

Knee ligament injuries are common in athletes involved in contact sports such as football, rugby and netball. Knee ligament injuries are graded based on the severity of injury. In grade I injuries, the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II injuries, there is a partial tear of the ligament. In grade III injuries, there is a complete tear of the ligament and the ligament is divided into two halves making the knee joint unstable. The surgical repair of a completely torn ligament involves reconstruction of the torn ligament using a tissue graft taken from another part of the body, or from a donor. The damaged ligament is replaced by the graft and fixed to the femur and tibia using metallic screws/clips/staples. Gradually, over a period of several months, the graft heals into the bone.

Arthroscopic reconstruction of knee ligaments is minimally invasive surgery performed through a few tiny incisions. An arthroscope is inserted into the knee joint through one of the small incisions to provide clear images of the surgical area (inside the knee) to the surgeon on a high definition monitor. Guided by these images, the surgeon performs the surgery using small surgical instruments inserted through the other small incisions around the knee. As arthroscopic surgery is performed through small incisions it provides the following benefits:

• Less post-operative pain
• Shorter hospital stay
• Quicker recovery.

Following arthroscopic reconstruction of injured ligaments, the rehabilitation goal is to get athletes ready to return to their sport.