Ligaments are part of the tissue surrounding a joint, and help to provide support and stability. When a ligament is torn or damaged in some way, the knee may become unstable, causing problems with mobility, as well as considerable pain.
The main ligaments of the knee are the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament. In cases where more than one ligament needs to be repaired because of an injury, Dr Marais may recommend multi ligament repair.
Before performing surgery, Dr Marais will diagnose your condition and determine the extent of your injury. He may perform an x-ray in order to see if any bones have been fractured, as well as an MRI. An MRI will allow Dr Marais to see the ligaments clearly, and he will be able to determine how many of them are torn. If further diagnosis is required, Dr Marais may use arthroscopy in order to look inside the joints and plan for the surgery. The procedure is performed under general anaesthetic, and a tissue graft is surgically removed from the body of the patient. This tissue graft is used to reconstruct the anterior or posterior cruciate ligament. The tissue graft is removed by making a small incision of the area where the graft is removed. The rest of the procedure is performed arthroscopically which is a much less invasive technique than traditional open surgery, and typically allows for a quicker recovery time and less pain post-surgery.
Dr Marais will insert small arthroscopic tools through 2 - 3 1cm incisions around the knee joint. This is done to remove the torn ligaments and to clean up the knee from any other damage. He will create holes the size of the graft that was harvested from the patient’s body in the tibia and femur. This is done specifically in the attachment site of the ligaments both on the femoral and tibial side. The new ligament is grafted into the bone. Dr Marais will likely place a brace on the leg in order to stabilise the knee. Dr Marais will insert small tools through the incision in the knee and carefully reattach the ligaments. In most cases, the ligaments are stitched together and reattached with the use of a tissue graft, although sometimes a brace and surgical screws may be required to keep the ligaments in place and properly stabilise the knee.
The medial and lateral collateral ligaments are repaired using an incision over the torn ligament. . Most repairs are done by suturing these ligaments or augmenting the repair with tissue grafts. This surgery cannot be performed arthroscopically and is done using an external cut over the area of the ligament injury. After surgery Dr Marais will make use of metals or bio-absorbable screws, a special device known as suture anchors or surgical stitches to repair these ligaments.
After the surgery, Dr Marais will advise you on the best rehabilitation plan, which may include physical therapy, and some lifestyle changes.