LIGAMENT RECONSTRUCTION
The ligaments of the knee provide stability to the joint. When a ligament is torn or severely stretched, rendering it incompetent, it must be reconstructed for stability of the joint to be restored. Dr. Bedford specializes in ligament reconstruction surgery. Read on to learn more about the details of a specific procedure, its related diagnosis, and what to expect following surgery.
ACL Reconstruction
The ACL, or Anterior Cruciate Ligament, is a ligament deep in the middle of the knee serving to provide stability to the knee joint. This ligament, in conjunction with the PCL (Posterior Cruciate Ligament), prevents the tibia and femur bones of the knee from gliding back and forth on one another. When the ACL is torn and there is increased movement of the tibia and femur in relation to one another, the knee becomes unstable. This leads to symptoms of locking, giving out, buckling, and swelling of the knee. The ACL can be torn in a variety of ways: a plant-and-twist (pivot) injury, or a fall or trauma. An examination in the office as well as MRI imaging will confirm the presence of a torn ACL.
ACL
PCL
knee cap
PCL
torn ACL
knee cap
Reconstructed ACL
When the ACL tears, the vessel supplying blood to the ligament also tears. This leads to devitalized, unrepairable tissue. For this reason, if you have an ACL tear, Dr. Bedford will recommend a surgical ACL reconstruction. Dr. Bedford performs arthroscopically assisted ACL reconstruction surgery, allowing it to be minimally invasive. A graft is used to recreate the ACL, either from a donor or using a piece of your own tissue. This graft is reinserted into the knee through tunnels and anchored into place.
Following ACL reconstruction surgery, your leg will be in a long leg hinged knee brace keeping your knee in extension (all the way straight). You are able to bear weight and walk while in this brace to your level of comfort. You will be in this brace for an estimated four weeks. Physical therapy should begin within two days of your surgery to minimize pain and swelling and improve range of motion and strength of the knee. Overall recovery to your pre-surgery level of activity is estimated to be 6-9 months; however, you will begin lighter levels of physical activity such as jogging as soon as three months post operative.
MPFL Reconstruction (Kneecap Stabilization)
The MPFL, or Medial Patellofemoral Ligament, is the ligament keeping the kneecap, or patella, from dislocating. The MPFL stabilizes the kneecap, and when a kneecap dislocation occurs, the MPFL may tear or become stretched out. Without a competent MPFL, the kneecap can recurrently dislocate. Kneecap dislocations cause a swollen, painful knee often with the feeling of a clunk or pop. In addition to causing knee pain, kneecap dislocations can cause damage to the cartilage on the underside of the kneecap. This can occur for a variety of reasons: a plant-and-twist (pivot) injury, or a fall or trauma. An examination in the office as well as MRI imaging will confirm the presence of a torn MPFL or any cartilage injuries to the underside of the kneecap.
If you have a torn MPFL, a recurrently unstable kneecap, or a large cartilage injury to the underside of your kneecap, Dr. Bedford may recommend surgical reconstruction of the MPFL and treatment of the cartilage lesions. Dr. Bedford performs arthroscopically assisted MPFL reconstruction surgery, allowing it to be minimally invasive. A graft is used to recreate the MPFL. This graft is inserted in the position of the narrative MPFL through tunnels and anchored into place. If a cartilage injury to the kneecap is present, this will be addressed separately at the time of surgery.
Following MPFL reconstruction surgery, your leg will be in a long leg hinged knee brace keeping your knee in extension (all the way straight). You are able to bear weight and walk while in this brace to your level of comfort. You will be in this brace for an estimated four weeks. Physical therapy should begin within two days of your surgery to minimize pain and swelling and improve range of motion and strength of the knee. Overall recovery to your pre-surgery level of activity is estimated to be 6-9 months; however, you will begin lighter levels of physical activity such as jogging as soon as three months post operative.
UCL Reconstruction or "Tommy John Surgery"
The UCL, or Ulnar Collateral Ligament, is a ligament on the pinky (medial or ulnar) side of the elbow providing stability to the elbow joint, especially during a throwing motion, when the medial side of the elbow is under an enormous amount of stress. When the UCL is torn, there is nothing bracing the medial side of the elbow or keeping it from stretching or opening under stress. This leads to symptoms of elbow pain, swelling, feelings of instability, and often numbness, tingling, or a “funny bone” sensation due to the proximity of the ulnar nerve (the “funny bone” nerve) to the UCL. The UCL can be torn in a few ways, though most often it is torn via a throwing mechanism (such as when pitching a baseball). An examination in the office as well as MRI imaging will confirm the presence of a torn UCL.
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When the UCL tears, the fibers stretch and often heal incorrectly, leading to an incompetent ligament. For this reason, if you have a high grade partial, chronic, or complete UCL tear, Dr. Bedford will recommend a surgical reconstruction. A graft is used to recreate the ACL, either from a donor or using a piece of your own tissue. This graft is inserted into the elbow through an open incision and anchored into place. Dr. Bedford also performs UCL reconstructions with an internal brace, or strong suture to augment the ligament reconstruction and accelerate rehabilitation and return to physical activity.
Following UCL reconstruction surgery, your arm will be in a splint followed by an elbow brace and sling to protect the reconstruction while it heals. You will begin physical therapy about two weeks after surgery to regain range of motion and strength and must be careful not to stress the inside (ulnar) side of the elbow at any time while the reconstruction heals. Overall recovery to your pre-surgery level of activity, such as unrestricted baseball pitching, is estimated to be 6-8 months; however, you will begin lighter levels of physical activity such as a progressive throwing program as soon as four months post operative.​