Ligament Damage: Repair Options and Surgical Insights

Ligament tear

In early December of the previous year, I dislocated my patella after being hit by a ball on my knee.
After seeking medical attention, I was placed in a brace for two weeks.
The first doctor I consulted mentioned that I might have injured my ligaments but suggested that I could wait for it to heal on its own and recommended doing more straightening and strengthening exercises.
After that, the situation remained unresolved.
However, on November 22 of this year, while playing badminton, I jumped and subsequently dislocated my patella to the right.
After undergoing an MRI, it was discovered that there was ligament damage.
The physician advised surgery for repair since this was my second dislocation.
I would like to know if the ligament is truly beyond repair.
Additionally, what does ligament repair entail, and what types of materials are used for the repair?

Aki, 10~19 year old female. Ask Date: 2018/12/16

Dr. Shi Guozheng reply Orthopedics

There are four ligaments in the knee joint, and it's unclear which one is injured and the extent of the injury.
If the anterior or posterior cruciate ligament is damaged, reconstruction may be necessary.
If the patella is laterally displaced, a realignment operation may be required, which involves tightening the medial structures and loosening the lateral ones.
For detailed information, it is essential to consult the surgeon directly.

Reply Date: 2018/12/16

More Info

Ligament injuries, particularly in the knee, can be quite complex and often require careful evaluation and management. Based on your description, it seems that you have experienced recurrent dislocations of your patella (kneecap), which can lead to damage of the surrounding ligaments. This is a common issue in sports-related injuries, especially in activities that involve jumping or sudden changes in direction, such as badminton.

When a ligament is damaged, it can range from a mild sprain (where the ligament is stretched but not torn) to a complete tear. In your case, since the MRI has indicated that there is a ligament tear, it suggests that the injury is more severe. Ligament tears can lead to instability in the joint, which is likely why you are experiencing recurrent dislocations. The recommendation for surgical intervention is often based on the degree of instability and the impact it has on your daily activities and athletic performance.

Surgical repair of a torn ligament typically involves suturing the torn ends of the ligament back together. In some cases, if the ligament is too damaged, a graft may be used. A graft can be taken from another part of your body (autograft) or from a donor (allograft). Common materials used for grafts include:
1. Patellar Tendon Graft: This is taken from the middle third of the patellar tendon, which connects the kneecap to the shinbone. It is a strong option and is commonly used in ACL (anterior cruciate ligament) reconstruction.

2. Hamstring Tendon Graft: This involves harvesting tendons from the hamstring muscles at the back of the thigh. This option is less invasive and can lead to less postoperative pain.

3. Quadriceps Tendon Graft: This is taken from the quadriceps muscle above the kneecap and is another strong option for ligament reconstruction.

4. Allograft: This is a graft taken from a deceased donor. It can be advantageous as it avoids additional surgery to harvest tissue from your own body, but it may carry a slightly higher risk of complications such as infection or rejection.

The surgical procedure aims to restore stability to the knee joint, allowing you to return to your normal activities and sports without the fear of further dislocations. Post-surgery, rehabilitation is crucial. It typically involves physical therapy to strengthen the muscles around the knee, improve range of motion, and restore function.

In terms of prognosis, many patients who undergo ligament repair surgery can expect a good outcome, especially if they adhere to their rehabilitation program. However, the success of the surgery can depend on several factors, including the extent of the injury, the specific ligament involved, and your overall health and activity level.

It's important to have a thorough discussion with your orthopedic surgeon about the specifics of your injury, the proposed surgical technique, and the expected recovery process. They can provide personalized insights based on your unique situation and help you make an informed decision about your treatment options.

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