The knee is supported by four ligaments: one on the inside, one on the outside, and two in the middle. The MCL (Medial Collateral Ligament) is on the inside, the LCL (Lateral Collateral Ligament) is on the outside, and the cruciate ligaments are in the middle of the knee. The ligaments are usually only ripped in one or two places. More than two ligaments are rarely damaged, and all four ligaments are torn in rare cases.
The PCL (posterior cruciate ligament) is a key knee ligament. It is located in the back region of the knee, in the center. It is in charge of preventing the knee from moving backward. It can be harmed if the knee is struck from the front, such as in a head-on collision where something strikes the knee from behind. The injury to this ligament is not as severe, and it is frequently overlooked. It was once considered that a PCL injury could be left alone and would not create any problems. However, because it is now recognized that the PCL is a vital ligament, injury to it often necessitates surgical restoration. It’s a delicate operation since part of it takes place at the back of the knee, near vital nerves and blood vessels in the leg. Keyhole (arthroscopic) surgery is used to perform this procedure.
What is the PCL?
The PCL (posterior cruciate ligament) is a key knee ligament. It is located in the back (posterior) region of the knee, in the center. It is in charge of preventing the knee from moving backward.
How is it injured?
It can be damaged if the knee is struck from behind, such as in a head-on collision if something strikes the knee from behind. The injury to this ligament is not as severe, and it is frequently overlooked.
Does it need surgery if torn?
It was once considered that a PCL injury could be left alone and would not create any problems. However, because it is now recognized that the PCL is a vital ligament, most injuries to this ligament require surgical restoration.
How is this surgery done?
This is an arthroscopic (keyhole) procedure. If the ligament is torn in the middle, a new ligament is created using tendons grafted from the rear of the knee (hamstring tendons). Specialized devices are used to secure the graft to the leg and thigh bones. PCL reconstruction is the name for this technique. PCL is repaired by key-hole surgery if it falls off with a fragment of bone.
Arthroscopic PCL Reconstruction Technique
What are the results of PCL surgery?
The results are outstanding, with only a 5% possibility that the transplant would not be accepted by the body. This necessitates the use of appropriate rehabilitative approaches.
What are the complications?
Apart from the usual risks involved with any ligament surgery, there is a slight chance that the vessels at the back of the knee will be injured during this procedure. They are, however, uncommon if surgery is performed properly.
What is PCL refixation?
When a portion of bone comes loose from the PCL, this surgical method is used. The ligament is not repaired (i.e., no new ligament is created), but arthroscopic procedures are used to reattach the ligament to the bone. The rehabilitation process is nearly the same as that of a PCL reconstruction.
Arthroscopic PCL re-fixation :
Avulsion of the PCL from the tibia can be diagnosed by x-rays and MRI. The best way to treat an avulsion injury is to put it back in its proper place. The back of the knee is a sensitive location, with all of the leg’s major nerves and veins passing through it. This used to be done through open surgery. This can now be done arthroscopically thanks to advancements in arthroscopic methods.
What is post-operative rehabilitation?
It’s very similar to an ACL reconstruction. The only difference is that support is placed beneath the upper part of the leg, and the patient must walk for 6 weeks while wearing a long knee brace.
In the prone position, flexion and extension movements are performed. The limitations are slightly more severe than following an ACL reconstruction and walking returns to normal after around 6 weeks. After 4-5 months, you can start running and jogging, and after 6-9 months, you can start sports.
When a knee bends inside or is impacted from the outside, the MCL (medial collateral ligament) is frequently injured. This is one of the simpler ligaments to mend because it usually recovers with just rest and a brace. When this ligament is torn in conjunction with other ligaments, such as the ACL, or in obese patients, it may require surgical treatment – repair or reconstruction.
Do we always need to operate on it?
When torn from the thigh bone or the middle of its substance, this is a relatively friendly ligament that heals in roughly half of the instances. This process takes around 6 weeks and necessitates some form of immobility, such as a brace.
When do we need to operate?
When the knee continues to open up from the inside after 6-8 weeks, or if the injury is at the attachment to the leg bone, surgery is required. When several ligaments of the knee are injured, it is sometimes necessary to restore the knee as soon as possible.
What kind of operation is done?
There are two types of operations for MCL injury.
1. When the ligament has just come loose from its attachment at either end, it is repaired. The original ligament is simply mended and returned to its proper position. Internal splintage, or supporting the mending ligament with a thick tape-like structure, is something we perform occasionally.
2. When a ligament is fully torn and no longer has its original structure, it is reconstructed. The tendons of the hamstrings (semitendinosus/gracilis) are used to create a new ligament, which is then secured using specialized devices.
What is post-op rehabilitation?
This is dependent on whether the MCL is operated on alone or in conjunction with another ligament.
If the procedure is performed in isolation, the patient is placed in a lengthy knee brace for 6 weeks and then allowed to bend the knee off of the brace while remaining cross-legged. Using the brace, you can walk with a walker or crutches. The patient must, however, wear the brace while walking for the next six weeks.
The rehabilitation depends on which other ligament is rebuilt if additional ligament reconstruction is done.
Postero-lateral Corner injuries:
What is the posterolateral corner?
On the back of the outside aspect of the knee, is a portion of the knee. The popliteus tendon and the lateral collateral ligament are the two main components.
Does it require reconstruction?
Almost frequently, it needs reconstruction. It is almost always found in conjunction with ACL or PCL tears that are rebuilt at the same time.
How is it reconstructed?
The semitendinosus and gracilis (hamstring tendons) of the other legs are fashioned into one or both of these ligaments and attached to the thigh and leg bone at their corresponding positions.
What is post-operative rehabilitation?
For the first two weeks, the patient wears a lengthy knee brace, then a hinged knee brace with crutches or a walker. Out of the brace, but in a prone position, movement is permitted.
Multiple ligament injuries to the knee:
In serious accidents, this type of catastrophic damage happens. Frequently, the knee dislocates or becomes quite unstable. Even moving the leg in bed becomes impossible. Any attempt to place weight on the leg causes the knee to ‘give way.’ Blood oozing out beneath the skin causes a bluish discoloration of the knee in the early stages. Damage to the nerves and arteries of the leg may occur in severe injuries, making the injury limb-threatening. These injuries would necessitate surgery in the majority of young and active patients. These operations are extremely specialized, and only a few surgeons with extensive experience in this field are capable to perform them successfully. Physiotherapy after surgery is a crucial aspect of the entire recovery process.