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Ligament Reconstruction

What is Ligament Reconstruction?

Ligament reconstruction is surgery to reconstruct a torn ligament using a graft or artificial prosthesis. Ligaments are tough, non-stretchable fibers that hold your bones together. Ligament reconstruction is performed to improve joint function and stability and may be indicated for shoulder, elbow and knee injuries.

Shoulder Ligament Reconstruction

Why is Shoulder Ligament Reconstruction Performed?

Shoulder ligament reconstruction is performed to:

  • Improve stability of the shoulder joint
  • Restore function
  • Prevent dislocations

What are the Commonly Injured Ligaments in the Shoulder?

Several ligaments support the shoulder joint. The ones commonly injured include:

  • Acromioclavicular ligament
  • Coracoclavicular ligament

What Happens During Shoulder Ligament Reconstruction?

Shoulder ligament reconstruction surgery involves the repair of torn or stretched ligaments so that they are better able to hold the shoulder joint in place.

Shoulder ligament reconstruction surgery can be performed arthroscopically through small incisions using tiny instruments. Some patients may need an open surgical procedure which involves a larger incision over the shoulder to perform the repair.

During the surgery, overstretched capsules and ligaments are tightened. A tissue graft or artificial prosthesis may be used to reconstruct a shoulder ligament. It is inserted into holes drilled in the bone and secured.

Knee Ligament Reconstruction

What are the Ligaments that Support the Knee Joint?

Four major ligaments help stabilize the knee joint:

  • Anterior cruciate ligament or ACL
  • Posterior cruciate ligament or PCL
  • Medial collateral ligament or MCL
  • Lateral collateral ligament or LCL

The anterior cruciate ligament is the most commonly injured knee ligament.

What is Knee Ligament Reconstruction?

Knee ligament reconstruction involves replacing a torn knee ligament with part of a tendon taken from your leg. The goal of knee ligament reconstruction is to tighten the knee joint and restore its stability. It also helps you avoid further injury.

When is Knee Ligament Reconstruction Indicated?

Knee ligament reconstruction may be recommended if:

  • You have a severe ligament injury
  • Conservative treatments have failed to relieve knee pain and disability
  • You are an active adult who requires good knee stability for participation in work or sports

Procedure for Knee Ligament Reconstruction

The procedure is performed under general anesthesia. A tissue graft is harvested from the patellar tendon or hamstring tendon. The patellar tendon connects the bottom of the kneecap (patella) to the top of the shinbone (tibia). The hamstrings are muscles located on the back of your thigh.

For a patellar tendon graft, your surgeon makes an incision over the patellar tendon and takes out the middle third of the patellar tendon, along with its attachment to the bone. The remaining portions of the patellar tendon on either side of the graft are sutured back after its removal and the incision is closed.

For a hamstring tendon graft, a small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped of the muscle and the graft is prepared.

Your surgeon will make two small incisions around your knee. An arthroscope, a small video camera, is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the knee to expand it and enable your surgeon to have a clear view of the inside of the joint. The torn ligament is removed and the pathway for the new tissue graft is prepared.

The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones around the knee joint. These holes form tunnels in your bone to accept the new graft. The graft is then pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it in place while the ligament heals into the bone. The wounds are then closed with sutures and dressed.

Jill McAngus, M.D.
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