Fields of treatment / Orthopedy / Plastic surgery of the cruciate ligaments of the knee

Plastic surgery of the cruciate ligaments of the knee

Rupture of the anterior cruciate ligament is the most common type of traumatic injury to the soft structures of the knee. It is often accompanied by an injury to the meniscus and the internal collateral ligament. The occurrence of injuries is dominated by sports activities such as football, volleyball, handball, floorball or skiing, i.e. wherever there are rapid changes in the direction of movement and stopping of the limb.

Information and appointments

One Day Surgery Centre Hradec Králové
recepce@1chirurgie.cz / +420 495 269 768 (weekdays 10 a.m.-3 p.m)
Štefánikova 454/28a, 500 11 Hradec Králové (Hvězda Complex)

Symptoms and treatment

The dominant symptoms include sharp pain in the knee, inability to step on the affected limb associated with knee instability, significant swelling of the joint, and reduced muscle strength.

Treatment includes two methods - conservative (puncture, orthosis, physiotherapy) and surgical (operation), always taking into account the patient's age, associated injuries, the intensity of the load on the knee joint and sports activity.

Operative procedure

Plastic surgery of the cruciate ligaments of the knee is performed under general anesthesia, using an endoscopic mini-invasive surgical method - arthroscopy. It lasts around 60 minutes.

The operator usually introduces endoscopic optics through 2 small incisions together with working instruments and treats the affected intra-articular structures.He then performs a reconstructive plastic surgery of the injured ligament, in most cases using an autologous graft (own tendon) graft from the hamstring tendon (ST-G). The graft is fixed with absorbable interference screws or nails called cross-pins. The graft gradually undergoes histological remodeling and heals into the individual bones. Around 8 to 12 months, an almost full replacement of the previously damaged ligament will be created.Ligament healing can also be accelerated from an orthopedic point of view, for example by applying plasma or collagen directly to the joint.

After the surgery, 2 small scars from the surgical instruments in the joint and a scar from the graft removal (depending on the type of graft removed) are visible. Two drains are inserted into the wound, which drain the blood and thus prevent the accumulation of fluid in the intra-articular space.

FAQ

Preoperative examination and hospitalization period

Preoperative examination includes internal and laboratory examination. The standard length of hospitalization is 1 day within the so-called one-day surgery.

Operative treatment is always indicated in patients who have either a combined injury or are athletically active.The goal of the operation is to fully restore the stability of the knee joint and the range of motion and thus prevent further damage to the intra-articular structures with the subsequent unwanted development of arthritic changes in the joint.

Like any procedure under general anesthesia, ligament plastic surgery can be accompanied by complications. Complications at the procedure site may also occur, such as reduced sensitivity or numbness of the front of the knee and upper leg, enlargement of the scar, effusion, and limitation of range of motion.

Immediately after the operation, the patient is kept in the recovery unit, where he is regularly monitored and followed. Analgesics are administered to reduce pain.In order to prevent swelling and reduce the pain of the operated area, we attach cooling gel pads.Keep the limb in an elevated or horizontal position. We remove the drains according to the amount of secretion, usually 24 hours after the operation.

We attach an orthosis to the operated limb (even at night), which the patient wears 4-6 weeks after the operation, and thus protects the operated knee from unexpected movement, when there is a risk of injury to the non-grafted ligament. Walking is about 2 French crutches with a minimal step on the foot of the operated limb, all the weight is on the hands and non-operated limb.Walking with crutches is recommended for a total of 4 weeks after surgery.

The stitches are removed 8 - 14 days after the operation. If a separate plasty of the anterior cruciate ligament was performed, it is possible to walk on the operated limb after the swelling subsides (approximately from 3-5 days after the operation). Normal walking is usually 4-7 weeks after surgery.

It is possible to start with rehabilitation care after pulling out the stitches in about 14 days under the guidance of a physiotherapist. More active rehabilitation usually starts from 3 - 4 weeks, riding an exercise bike or rehabilitation with a motor splint is recommended. Correct and effective rehabilitation is an important means of achieving full range of motion, stability and strength of the knee joint.

The period of incapacity for work is individual and depends on the nature of the operational performance and work classification, in the range of 3-6 weeks.

The total recovery time depends on the extent of the operation. It is generally between 4-6 months. A return to sports activity is recommended in 6 - 12 months, depending on the type of sport.

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