What is Knee Trauma Reconstruction?
Knee trauma reconstruction is a surgical procedure to repair a soft-tissue injury of the knee such as a torn ligament using a tissue graft or replacing the damaged bony surfaces of the knee joint with an artificial knee joint called a prosthesis. Artificial knee joints are usually made of metal, ceramic or plastic, and consist of the femoral and the tibial components.
Knee Anatomy
The knee is the most complex joint in the body and is formed by the articulation of the thighbone (femur) and shinbone (tibia). A kneecap is present over the front of the joint to provide extra protection. These bones are held together by four strong rope-like structures called ligaments. Two collateral ligaments called the medial collateral ligament (MCL) and lateral collateral ligament (LCL) are present on either side of the knee, which control the sideways movement of the knee. The other two ligaments are the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) 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.
Indications for Knee Trauma Reconstruction
Your surgeon may recommend knee trauma reconstruction if you have:
- A direct impact to the knee, such as in an automobile accident
- A direct fall to the ground on a bent knee
- Direct blow to the side of your knee, such as during a football tackle
- Twisting injury or overextending the knee during sports
- Traumatic injury with severe rupture of knee ligaments
- Knee fracture/dislocation
- Knee deformity with loss of cartilage and pain
- Instability of the knee
- Failed non-surgical treatment remedies such as medications, injections, and physical therapy
Preparation for Knee Trauma Reconstruction
Preoperative preparation for knee trauma reconstruction will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Knee Trauma Reconstruction
The knee trauma reconstruction procedure is performed either arthroscopically or as an open surgery under regional or general anaesthesia. The type of reconstruction depends upon the severity of the trauma and the damage sustained by the knee joint and ligaments.
Knee Ligament Injuries
Knee ligament injuries are common in athletes involved in contact sports such as soccer, football, and basketball. Knee ligament injuries are graded based on the severity of the injury.
- Grade I: ligament is mildly damaged and slightly stretched, but the knee joint is stable
- Grade II: partial tear of the ligament
- Grade III: complete tear of the ligament and the ligament is divided into two halves, making the knee joint unstable
Arthroscopic Knee Ligament Reconstruction Procedure
The surgical repair of the 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. Gradually, over a period of a few months, the graft heals.
Arthroscopic reconstruction of the knee ligament is a 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 your surgeon on a television monitor. Guided by these images your surgeon performs the surgery using small surgical instruments inserted through the other small incisions around the knee.
Total Knee Replacement Procedure
The goal of the total knee replacement surgery is to replace damaged portions of the knee joint with a prosthesis to relieve pain and restore normal alignment and function of your knee.
The surgery is performed under regional or general anaesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then, the damaged portions of the femur bone are cut at appropriate angles using specialised tools. The femoral component is attached to the end of the femur with or without bone cement.
Your surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws.
Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia like the original meniscus cartilage.
The femur and the tibia with the new components are then put together to form the new knee joint.
To make sure the patella (kneecap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component.
With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed; drains are inserted, and a sterile dressing is placed over the incision.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after knee trauma reconstruction will involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anaesthetic reactions and monitor your vital signs as you recover.
- You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed.
- You are advised to keep your leg elevated while resting to prevent swelling and pain.
- You will be given assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
- An individualised physical therapy protocol will be designed to help strengthen knee muscles and optimise knee function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Knee trauma reconstruction is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Blood clots
- Infection
- Bleeding
- Anaesthetic/allergic reactions
- Injury to nerves and blood vessels
- Implant wear and loosening
- Failure to relieve knee pain or stiffness
- The need for revision surgery
