The cruciate and collateral ligaments are two groups of elastic tissue bands that are associated with the knee joint. There are two cruciate ligaments that form an “X” within the knee joint and are primarily responsible for limiting the forward and backward movement of the tibia (shin bone) in relation to the femur (thigh bone). Together, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) originate from the posterior (back) thigh bone and travel diagonally through the knee joint where they attach to the anterior (front) shin bone. The ACL can experience a tear within the ligament itself or become separated from its attachment site on the bone when it is stretched beyond its limits. The PCL is the strongest ligament within the knee joint and thus not as frequently injured due to its inherent strength. Athletes that play aggressive contact sports, such as wrestling or football, are more likely to sustain a PCL injury whereas athletes of all competitive ages and levels can incur an ACL injury.
Cruciate ligament injuries may benefit from conservative therapies in the event of an isolated posterior cruciate ligament (PCL) injury or when there is no knee instability as a result of the initial injury. Any combination of the following can be used as initial conservative therapy options: wearing a knee brace, limiting or avoiding weight-bearing on the injured knee, RICE (rest, ice compression, elevation), and non-steroidal anti-inflammatory medications (NSAIDs).
However, surgical intervention is frequently indicated when conservative therapies fail, multiple knee joint structures are damaged, or a complex or severe ACL tear was sustained. Cruciate ligament reconstruction is accomplished by integrating a tendon graft, either from the patient (autograft) or donor tissue (allograft), to replace the native ligament and provide a surface for new tissue development. An autograft is typically harvested from the patient’s hamstring tendon, quadriceps tendon, or patellar tendon. Allografts are generally favored by surgeons as these tissues can ease the recovery period while also reducing the risk of the ligament rupturing again. Dr. Frank McCormick, orthopedic knee doctor, treats patients in Orlando, Palm Beach County, and surrounding Florida communities, who have experienced a cruciate ligament injury and are in need of surgical reconstruction.
Cruciate ligament reconstruction is often performed as an outpatient procedure dependent upon a number of patient factors. Dr. McCormick first begins by conducting an examination under anesthesia to confirm the damaged ligaments and assess the integrity of the other knee joint structures. Following this exam, the previously designated tendon graft will be harvested from the patient or thawed from the donor. The reconstructive procedure then begins by creating several small incisions surrounding the knee joint. A small camera (arthroscope) is introduced to allow Dr. McCormick to methodically examine the bones, cartilage, and ligaments of the knee joint. Specialized surgical instruments are then inserted to excise and remove any damaged tissue fragments and complete any other necessary revisions.
The anterior cruciate ligament (ACL) is reconstructed by first tunneling small holes in the distal thigh bone and proximal shin bone. The designated tendon graft is passed through these bone tunnels and secured in place with special surgical anchors or interference screws. Reconstruction of the posterior cruciate ligament (PCL) also begins by creating small holes in the bones except these bone tunnels are located in the distal thigh bone and the head of the fibula (smaller bone next to the tibia). It is important that these tendon grafts are positioned as close to the native ligaments as possible to ensure the success of the new ligaments. When all revisions are complete, the new ligaments are assessed for stability and good tension, and the knee’s range of motion is evaluated. The arthroscope and surgical instruments are withdrawn from the knee joint and the incisions are closed with sutures or steri-strips.
The recovery period that follows cruciate ligament reconstruction is contingent upon the severity of ligament damage, the specific surgical approach conducted, and the type of tendon graft implemented by Dr. McCormick. While minimally invasive arthroscopic procedures have shown a reduction in the recovery time, the structures within the knee joint will still take the same amount of time to heal. Most patients can anticipate a return to their normal daily activities in approximately 6 to 9 months. In general, patients in the Orlando, West Palm Beach County, and surrounding Florida communities can expect the following during the recovery period:
For more information on medial patellofemoral ligament injuries, or the excellent treatment options available, please contact the office of Frank McCormick, MD, orthopedic knee specialist serving Orlando, Palm Beach County, and surrounding Florida communities.
