Ligament Operation

Surgery to repair damaged ligaments can restore stability and function to injured joints, but the journey from injury to full recovery requires commitment, patience, and proper rehabilitation.

Table of contents

• What Are Ligaments?
• Common Ligament Injuries
• When Surgery Is Needed
• How Ligament Reconstruction Works
• Timing of Surgery
• Recovery After Surgery
• Return to Activities

What Are Ligaments?

Ligaments are tough, fibrous bands of connective tissue in your body. They connect bones to other bones and help hold important body structures in place, including joints. These cord-like tissues are mostly composed of collagen (a strong protein) and elastin (a flexible protein), which makes them strong but flexible.^[3]

There are more than 900 ligaments in your body. Many of them are in your limbs, especially in your joints where movement occurs. Ligaments hold bones together and allow them to move in certain ways, while also preventing parts from moving too much or moving the wrong way. They reinforce joints and prevent them from twisting or dislocating.^[3]

Common Ligament Injuries

You can injure a ligament by pulling it too hard or forcing it to move in the wrong direction. This stretches or tears the ligament fibers apart. These injuries are called sprains and often happen during a sudden fall, twist or impact.^[3]

The knee is particularly vulnerable to ligament injuries. Four major ligaments help stabilize the knee joint. The anterior cruciate ligament (ACL) runs diagonally in the middle of the knee and prevents the lower leg bone from sliding out in front. The posterior cruciate ligament (PCL) keeps the shin bone from moving backward too far. The medial collateral ligament (MCL) gives stability to the inner knee, and the lateral collateral ligament (LCL) gives stability to the outer knee.^[4]

The ACL is the most commonly injured knee ligament, accounting for more than 40% of all sports injuries. Athletes who participate in high-demand sports like soccer, football, basketball, lacrosse and skiing are more likely to injure their ACL.^[2][5]

Shoulder ligaments can also be injured. The commonly damaged ones include the acromioclavicular ligament and coracoclavicular ligament. These injuries often happen in sports or from direct impacts.^[4]

When Surgery Is Needed

Not everyone with a torn ligament needs surgery. The need for surgery depends on the severity of the tear and the lifestyle of the patient. A completely torn ACL cannot heal on its own. However, studies have shown that in some patients who experience only a partial tear, the ligament may heal without the need for surgery.^[1]

People who have completely torn their ACL and who maintain an active lifestyle, especially competitive athletes, will usually be recommended for surgery. This allows them to return to their prior level of activity and avoid future injury. Young patients who participate in sports involving cutting and pivoting movements (soccer, basketball, lacrosse, football) are at increased risk of further knee damage if an ACL tear is left untreated.^[1]

In some older patients or others whose lifestyles do not include rigorous exercise with side-to-side movements, nonsurgical treatments may allow them to return to normal routines without surgery. Patients who participate in running, cycling, weightlifting, or exercise classes may be able to return to these activities without an intact ACL.^[1]

For mild or partial ligament tears, doctors usually first recommend nonsurgical options, including rest, medication, physical therapy or knee bracing, which may allow the joint to heal over time. But if the ligament is completely torn and limits even basic movements, surgery may be suggested for long-term stability and relief.^[2]

How Ligament Reconstruction Works

Ligament reconstruction is surgery to reconstruct a torn ligament using a graft or artificial replacement. The most common type is ACL reconstruction, in which the torn ligament is replaced with a tissue graft to mimic the natural ligament.^[1][4]

During the surgery, the torn ligament is removed from the knee and replaced it with a healthy tendon. This tendon can come from somewhere else in your own body or from donated tissue. The graft is usually taken from the patellar tendon (which connects the bottom of the kneecap to the top of the shin bone) or the hamstring tendon (muscles located on the back of the thigh).^[4][6]

Most ligament reconstruction surgeries are performed using a technique called arthroscopy. This is a minimally invasive approach that uses tiny tools and a camera inserted through a few small cuts around the joint. This technique offers many benefits compared to open surgery, including less damage to surrounding soft tissues, less post-operative pain, less scarring, fewer complications, and faster recovery.^[2]

During arthroscopic reconstruction, the surgeon makes small holes in the upper and lower leg bones around the knee joint. These holes form tunnels in the bone to accept the new graft. The graft is then pulled through these holes and fixed into the bone with screws to hold it in place while the ligament heals into the bone.^[4]

Timing of Surgery

For a complete tear of the ACL, reconstruction surgery is generally scheduled between 3 to 6 weeks after the injury occurs. This allows inflammation in the area to go down and allows time for physical therapy sessions to focus on restoring normal knee movement. If surgery is performed too early and in patients with limited knee range of motion, patients may develop severe scarring that leads to stiffness of the knee joint.^[1]

Delaying surgery beyond three months increases the risk of developing cartilage damage or injuries to other structures in the knee because of continual instability.^[1]

Recovery After Surgery

Recovery from ligament operation is a gradual process that requires patience and dedication. In the first days after surgery, you will typically be in a brace and on crutches. You will need to allow time for your body to heal from the surgery.^[10]

During recovery, it’s important to follow the R.I.C.E. model: Rest, Ice, Compression, and Elevation. General rest is necessary for healing. When you’re awake, try to ice your knee at least every two hours for 20 minutes at a time. Wrap an elastic bandage or compression wrap around your knee, and lie down with your knee propped up on pillows.^[7]

Most people will be on crutches for 1 to 2 weeks. You should keep your leg elevated at a minimum of a 45-degree angle, with your knee at least 12 inches above your heart for the first three to five days after surgery. Don’t put pillows behind your knee because this limits motion. Instead, place pillows under your heel and calf.^[11][12]

A low-grade fever up to 101 degrees Fahrenheit is common for four or five days after surgery. If your temperature is higher or lasts longer, contact your doctor. You can usually shower 24 to 48 hours after surgery if your doctor approves, but keep your bandage and cut dry. Do not take a bath, swim, use a hot tub, or soak your leg for 2 weeks or until your doctor says it’s okay.^[11][12]

Physical Therapy and Rehabilitation

Physical therapy typically begins within a week of surgery. Your rehabilitation program to restore range of motion to your knee actually begins the moment you wake up in the recovery room. During the first week after surgery, most patients are encouraged to lift their legs without assistance while lying on their backs.^[11]

The primary goal of physical therapy is to return the knee to normal function first, such as with walking, squatting, and getting up and down stairs. The knee has to recover from inflammation and start moving again. If only the ACL was reconstructed, it’s safe to say you will return to normal functioning by six weeks after surgery. If other tissue had to be repaired, recovery could take longer.^[10]

By the end of the second or third week, patients usually walk without crutches. The goal is to achieve a range of motion of 0 to 90 degrees by the time you return for your first post-operative visit a week after surgery. A range of motion of 0 to 140 degrees is a good goal for the first two months.^[11]

Physical therapy exercises include range-of-motion exercises (moving the knee up and down and side to side), strengthening exercises (such as calf raises, straight leg raises, squats, and step-ups), and balance exercises (balancing on one leg with the knee slightly flexed).^[10]

Sticking to your post-operative physical therapy, both during your visits and at home, is one of the most important components of a successful recovery. The true goal of physical therapy is to help you strengthen your knee gradually in order to prevent re-injury.^[13]

Important Recovery Guidelines

During recovery, there are important things you should and shouldn’t do. You should keep your knee straight immediately after surgery, even though this will not be comfortable. This gives the joint time to heal properly without stressing your newly-fixed ligament. Don’t put weight on your new knee until your surgeon says it’s okay. Wear your knee brace everywhere, all the time, as it will help protect and stabilize your knee while speeding up your recovery.^[14]

Don’t walk, swim, cycle, bend and extend your knee excessively until you’re cleared to do so. You may want to push your rehabilitation, but restraint is important. Go to all your scheduled follow-ups with your knee surgeon. The sooner he or she clears you, the sooner you get back to doing what you love.^[14]

For about 12 weeks, do not do any strenuous activity. This includes not only sports, but also things like mowing lawns, raking leaves, and shoveling snow.^[12]

Return to Activities

Most patients can jog in about 4 months and run or cycle in about 4 to 6 months. You may need to wear a knee brace when you play sports. However, it may be several months or more before you have complete use of your knee. It may take as long as 6 months to a year before your knee is ready for hard physical work or certain sports.^[1][12]

Don’t swim or run for five months. You can swim with your arms, without paddling your feet, at about two to three months after surgery.^[11]

How soon you can return to work depends on your job. If you sit at work, you may be able to go back in 1 to 2 weeks. But if you are on your feet at work, it may take 4 to 6 weeks. If you are very physically active in your job, it may take 4 to 6 months.^[12]

You can drive when you are no longer using crutches or a knee brace, are no longer taking prescription pain medicine, and have some control over your knee. For most people, this takes 1 to 2 weeks.^[12]

Research has shown that patients who undergo surgery tend to have higher stability measurements and may return to sports activities compared to those who receive only conservative treatment. However, studies measuring overall knee function and health have found mixed results, with some showing no significant difference between surgical and nonsurgical treatment in terms of overall function scores.^[9]

Even after surgery, your knee may not be as strong as it was before the injury. Surgery can help, but patience can mean the difference between getting you back on the field, the trail, or other activities, and spending more time recovering from complications. Knees are complex joints and if you push them too hard, and too early, during recovery, you may experience problems down the road.^[13]