Post-ACL Reconstruction: Concerns About Stability and Recovery

Post-Operative Care After Anterior Cruciate Ligament Reconstruction Surgery

Hello Dr.
Hong: The surgeon who performed my operation told me that one-third of the patellar ligament was used to reconstruct the posterior cruciate ligament (PCL).
I remember that before the surgery, when lying flat and bending my knee to perform the anterior and posterior cruciate ligament tests, there was slight movement when pushing from the front of the calf backward (indicating a PCL tear), while there was no significant movement when pushing from the back of the calf forward (indicating the anterior cruciate ligament, ACL, was normal).
However, after the surgery, it seems to be the opposite; now there is slight movement when pushing from the back of the calf forward.
I am concerned that the ACL might also be injured, but the surgeon said the ACL is fine.
Could it be that the removal of the patellar ligament has caused temporary instability in the knee joint? Does the patellar ligament have a function similar to that of the ACL? If this is related to the patellar ligament, I would feel reassured.
By the way, will the one-third of the patellar ligament that was removed grow back? Thank you for your response, Dr.
^^

Mark, 10~19 year old female. Ask Date: 2004/08/25

Dr. Hong Ximing reply Orthopedics

Hello Mark, thank you for your message.
After anterior cruciate ligament reconstruction, there may still be some forward movement of the tibia, which could be due to the differing tightness of the anterior and posterior cruciate ligaments.
If it is mild, it should be manageable, but protection is still necessary.
Additionally, strengthening the muscle power is essential to enhance joint stability.
The patellar ligament is missing one-third, and it is unlikely to regenerate, but it only affects a small amount of strength.
With diligent rehabilitation and muscle strengthening, compensation is possible.
Wishing you a speedy recovery.
Best regards, Hong Hsi-Ming.

Reply Date: 2004/08/25

More Info

After undergoing ACL reconstruction, it is common for patients to have concerns about knee stability and recovery. Your situation, where you experienced some instability after surgery, is not unusual and can be attributed to several factors.

Firstly, it is important to understand the role of the patellar tendon in ACL reconstruction. The patellar tendon, which connects the kneecap (patella) to the shinbone (tibia), is often used as a graft for ACL reconstruction. When a portion of this tendon is harvested for the surgery, it can lead to temporary changes in knee stability. The patellar tendon does play a role in stabilizing the knee, particularly during activities that involve bending and straightening the leg. After surgery, the knee may feel unstable as the surrounding structures, including muscles and ligaments, adapt to the changes made during the procedure.

Regarding your observation that pushing from behind the lower leg now results in some movement, it is essential to consider that the knee joint may still be healing. Post-surgical swelling, inflammation, and the healing process of the graft can all contribute to a feeling of instability. The graft itself takes time to integrate into the bone and surrounding tissues, which can affect its function during the early stages of recovery.
Your surgeon's assessment that the ACL is intact is reassuring. However, it is also possible that the knee's overall stability is temporarily affected due to the healing of the patellar tendon and the surrounding structures. The patellar tendon does not have the same function as the ACL, but it does contribute to the overall stability of the knee.
As for your concern about whether the harvested portion of the patellar tendon will grow back, it is important to note that the tendon will not regenerate in the same way that other tissues might. However, the remaining portion of the tendon can adapt and strengthen over time. Rehabilitation exercises focusing on strengthening the quadriceps, hamstrings, and other supporting muscles around the knee will be crucial in restoring stability and function.
In terms of recovery, it is vital to follow your rehabilitation program closely. This typically includes physical therapy aimed at restoring range of motion, strength, and stability. Gradually increasing the intensity of your exercises, while being mindful of any discomfort or instability, will help you regain confidence in your knee.
If you continue to experience instability or have concerns about your knee's function, it is essential to communicate with your orthopedic surgeon or physical therapist. They can provide a thorough evaluation and determine if any additional interventions or modifications to your rehabilitation plan are necessary.

In summary, while it is normal to have concerns about knee stability after ACL reconstruction, the changes you are experiencing may be part of the healing process. The patellar tendon does play a role in knee stability, and while it will not regenerate, the remaining tendon can strengthen over time. Adhering to your rehabilitation program and maintaining open communication with your healthcare providers will be key to a successful recovery.

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