Knee and Lower Leg

ACL Reconstruction 

ACL reconstruction surgery replaces the torn anterior cruciate ligament (ACL) in the knee with a graft to restore stability and function. This procedure is crucial for athletes and active individuals seeking to return to high-level physical activities.

ACL (anterior cruciate ligament) reconstruction is a surgical procedure commonly performed to repair a torn ACL in the knee. The ACL is one of the major ligaments in the knee that helps provide stability during movement, particularly rotational movements and sudden changes in direction. When the ACL is torn, it can lead to instability in the knee, pain, and difficulty with activities that require agility and stability.

Here’s an overview of the ACL reconstruction procedure:

Preoperative Evaluation: Before surgery, the orthopedic surgeon will conduct a thorough evaluation of the knee, which may include physical examination, imaging studies such as MRI, and assessment of the patient’s symptoms and functional limitations.

Surgical Procedure: ACL reconstruction is typically performed arthroscopically, using small incisions and a tiny camera (arthroscope) to visualize the inside of the knee joint. During the procedure, the surgeon will:

  • Remove any remaining torn ACL tissue.
  • Prepare the knee for graft placement by drilling tunnels in the femur and tibia, where the ACL attaches.
  • Harvest a graft, which may come from the patient’s own tissue (autograft) or a donor (allograft). Common autograft options include the patellar tendon, hamstring tendons, or quadriceps tendon.
  • Insert the graft into the tunnels and secure it in place using screws, buttons, or other fixation devices.
  • Perform any additional procedures as needed, such as repairing meniscal tears or addressing other associated injuries.

Postoperative Rehabilitation: Following ACL reconstruction, a structured rehabilitation program is crucial for optimal recovery and outcomes. The rehabilitation process typically involves:

  • Protecting the knee with bracing or a knee immobilizer initially.
  • Physical therapy to regain range of motion, strength, and stability.
  • Gradual return to weight-bearing and functional activities.
  • Sport-specific training and neuromuscular re-education to reduce the risk of reinjury.

Recovery and Return to Activity: The timeline for returning to sports or other high-demand activities varies for each individual but generally takes several months. Athletes may require a longer recovery period before returning to full sports participation, often ranging from 6 to 12 months post-surgery.

ACL reconstruction aims to restore stability to the knee, reduce symptoms, and allow patients to return to their desired level of activity. However, it’s important to note that ACL reconstruction does not guarantee the prevention of future knee injuries or the development of osteoarthritis, particularly in cases of additional knee damage or poor rehabilitation compliance. 

PCL Reconstruction

The posterior cruciate ligament (PCL) is one of the major ligaments in the knee joint, and it plays a crucial role in stabilizing the knee and controlling its movement. While it is not as commonly discussed or injured as the anterior cruciate ligament (ACL), the PCL is nonetheless important for overall knee function. Here are the primary functions of the posterior cruciate ligament:

  • Stabilization of the Knee: The PCL helps to stabilize the knee joint by preventing excessive backward movement of the tibia (shinbone) relative to the femur (thighbone). This backward stability is particularly important during activities such as walking, running, and changing direction, as it helps maintain the alignment and integrity of the knee joint.
  • Prevention of Posterior Translation: The primary function of the PCL is to resist posterior translation or displacement of the tibia relative to the femur. This means that the PCL prevents the shinbone from moving too far backward in relation to the thigh bone. This stability is especially crucial during activities that involve forces pushing the tibia backward, such as when the knee is flexed or during activities like squatting or landing from a jump.
  • Supporting Rotational Stability: While the PCL primarily resists backward movement of the tibia, it also contributes to rotational stability of the knee joint to some extent. It helps control internal and external rotation of the tibia relative to the femur, although its role in rotational stability is secondary compared to its primary function of preventing posterior translation.

LCL, MCL Reconstruction 

This surgery addresses tears in the posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and medial collateral ligament (MCL). Reconstruction of these ligaments restores knee stability and function, essential for both athletic and everyday activities.

MPFL Reconstruction 

Medial patellofemoral ligament (MPFL) reconstruction aims to correct instability and realign the patella (kneecap) within the knee joint. This surgery is particularly effective for patients experiencing recurrent patellar dislocations.

Meniscus Repair 

Meniscus repair involves surgical correction of tears in the meniscus, a key cushioning cartilage in the knee. This procedure helps relieve pain, improve knee function, and can prevent long-term degenerative changes in the knee joint.

Meniscus Transplant 

Meniscus transplant replaces damaged or removed meniscal cartilage with donor tissue. This procedure is aimed at patients with significant meniscus damage, seeking to alleviate pain and improve knee function while delaying the onset of arthritis.

Osteotomies 

Osteotomy procedures realign the knee by cutting and reshaping the bones to relieve pressure on damaged areas. Subcategories include:

  • High Tibial Osteotomy: Adjusts the shinbone (tibia) to relieve pressure on the knee joint.
  • Tibial Tubercle Osteotomy: Moves the attachment of the patellar tendon to alter patellar tracking.
  • Distal Femoral Osteotomy: Reshapes the thigh bone (femur) to correct knee alignment.

Patellofemoral Joint Replacement 

This surgery replaces the damaged portion of the knee involving the patella and its groove on the femur, offering pain relief and improved function for patients with isolated patellofemoral arthritis.

Chronic Exertional Compartment Syndrome 

Treatment for this syndrome, characterized by muscle and nerve pain due to exercise, may involve surgery to release pressure in the affected muscle compartments, providing relief and improving exercise tolerance.

Patellar Tendon Repair/Reconstruction 

This procedure repairs or reconstructs the patellar tendon if it’s torn from the kneecap or shinbone. Essential for restoring knee stability and function, it’s particularly relevant for patients with acute injuries or degenerative conditions.

Quadricep Tendon Repair/Reconstruction 

Surgery to repair or reconstruct a torn quadricep tendon at the knee is critical for regaining leg strength and function. This treatment is vital for individuals who have suffered a tear through trauma or degenerative processes.

Limb Lengthening 

Limb lengthening procedures gradually increase the length of a bone using external or internal devices. This complex process is used for patients with limb length discrepancies or short stature, aiming to improve function and cosmetic appearance.