ACL and LCL Reconstruction: Key Questions Answered

Q: ACL and LCL Reconstruction: Key Questions Answered

Hello, in response to your questions：<br>1. <br>The purpose of the surgery is to restore your original function. <br>Your description did not mention your symptoms. <br>In some cases, even if the posterior cruciate ligament (PCL) and lateral ligaments are torn, clinical outcomes

Ligament reconstruction

Hello Dr.
Lee,
I previously had a car accident and underwent examinations and an MRI.
The doctor determined that I have a partial tear of the posterior cruciate ligament (PCL) in my left leg, and a complete tear of the PCL and a lateral collateral ligament (LCL) tear in my right leg.
I will be undergoing reconstruction soon.
I have a few questions for you:
1.
I have consulted two hospitals.
One stated that my right PCL and LCL are completely torn and that I need reconstruction of both ligaments.
The doctor was very certain about the LCL tear and repeatedly had what seemed to be a resident physician examine me.
He used a manual examination technique to check my right leg by rotating it outward, which indicated that the bone had shifted laterally and there was some pain.
The other hospital had a similar opinion regarding the PCL, but during the initial manual examination, they did not find any issues with the LCL.
When I mentioned the other doctor's opinion, they re-examined me and suggested that there might be a slight tear, but reconstruction was not necessary because the LCL would heal on its own.
What should I do?
2.
The first hospital indicated that I have multiple tears and that part of the reconstruction would involve using a donor ligament.
Are there any disadvantages to using a donor ligament? If a donor ligament is necessary, can I use donor tissue for all the reconstructions?
3.
The two hospitals suggested different donor sites: one suggested using a tendon, while the other recommended using the patellar tendon.
Which option is better? Which one has fewer long-term complications?
4.
Both hospitals stated that my left leg does not require reconstruction and that rehabilitation is sufficient.
Will this allow me to engage in sports in the future without issues? Would reconstruction be better for my knee in the long run?
5.
Is it feasible to reconstruct the ligaments in both legs at the same time? I am considering that I might need to reconstruct my left leg later, and I prefer to address everything in one procedure rather than experiencing prolonged pain.
6.
After reconstruction, will the ligaments be more prone to tearing? Will my athletic performance be significantly affected? (I really enjoy sports.)
I apologize for asking so many questions at once, but I take this surgery very seriously.
Thank you for taking the time to respond.

Xiao Zhang, 20~29 year old female. Ask Date: 2006/09/21

Dr. Li Wenlin reply Orthopedics

Hello, in response to your questions:
1.
The purpose of the surgery is to restore your original function.
Your description did not mention your symptoms.
In some cases, even if the posterior cruciate ligament (PCL) and lateral ligaments are torn, clinical outcomes can still be satisfactory with the use of braces and muscle strengthening.
Not every case requires surgery.
As for which hospital to choose for the surgery, it depends on whom you trust more.
You should investigate the reputation of both hospitals and the qualifications of the attending physician; this is something you need to research yourself.
2.
For PCL reconstruction, most often, your own ligament is used for the graft.
However, if the lateral ligament also requires surgery, and the commonly used grafts have already been utilized, another ligament from the opposite leg or a donor graft may be necessary.
Donor grafts are preserved through freezing and generally are not as good as your own; they are used out of necessity and may be inferior in terms of tissue strength and healing speed compared to your own ligaments.
3.
Harvesting tendons or patellar ligaments each has its advantages and disadvantages.
The deciding factor should be the proficiency of the attending physician.
You should follow their recommendation for the method they are most confident in and have the highest success rate.
4.
A partial tear of the PCL will certainly have some impact, but the extent of this impact can vary greatly depending on how you rehabilitate and protect yourself during future activities.
Most cases do not require surgery.
5.
Performing surgery on both legs simultaneously is not difficult for the physician, but your rehabilitation would be relatively challenging, and mobility would be limited (you would need to use a wheelchair).
It is advisable to address the right leg first.
6.
The strength and function of the reconstructed ligament may potentially return to 100% (though this is not the case for everyone), and there is indeed a possibility of re-tearing (as the strength may not match the original).
Therefore, the range of motion for future activities should be advised by the attending physician, and you should not rush into it.

Reply Date: 2006/09/21

More Info

Understanding ACL (anterior cruciate ligament) and LCL (lateral collateral ligament) reconstruction is crucial, especially after experiencing significant knee injuries. Your concerns are valid, and I will address each of your questions in detail.

1. Diagnosis Discrepancies Between Hospitals:
It’s not uncommon for different medical professionals to have varying opinions based on their assessments and examinations. The anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) are critical for knee stability. If one physician has confirmed a complete tear of the ACL and LCL, while another is uncertain, it may be beneficial to seek a third opinion or request further imaging, such as an MRI, specifically focusing on the LCL. The physical examination techniques can vary, and sometimes subtle injuries may not be immediately apparent. If the first hospital is confident in their assessment, it might be wise to consider their recommendation for reconstruction, especially if you are experiencing pain and instability.

2. Use of Donor Tissue for Reconstruction:
When reconstructing ligaments, surgeons often use grafts from either the patient (autograft) or a donor (allograft). Using donor tissue can be beneficial as it may reduce recovery time and surgical site morbidity. However, there are risks associated with allografts, including the potential for disease transmission and the body’s immune response to the graft. If a significant portion of your ligament is damaged, using a graft from a donor may be necessary. While it is technically possible to use allografts for both ligaments, the decision should be based on your specific injury, surgeon's preference, and the potential for better outcomes.

3. Graft Source: Tendon vs. Patellar Tendon:
The choice between using a tendon (like the hamstring tendon) or the patellar tendon for reconstruction depends on various factors, including the surgeon's experience and your specific anatomy. Both graft types have their advantages and disadvantages. Hamstring grafts tend to have less postoperative pain and quicker recovery, while patellar tendon grafts may provide better stability. Discuss with your surgeon which option they recommend based on your injury and their experience.

4. Rehabilitation of the Left Knee:
If the left knee does not require reconstruction and only needs rehabilitation, it is essential to follow a structured physical therapy program. This will help strengthen the knee and improve function. However, if you experience any pain or instability during activities, it is crucial to communicate this with your healthcare provider. While rehabilitation can be effective, it may not restore the knee to its pre-injury state, especially if there are underlying issues.

5. Simultaneous Reconstruction of Both Knees:
Performing simultaneous reconstructions on both knees is a complex decision. While it can be more convenient and may reduce the overall recovery time, it also increases the risk of complications and may affect your rehabilitation process. Discuss this option thoroughly with your orthopedic surgeon to weigh the benefits and risks.

6. Risk of Re-injury and Performance Post-Surgery:
Reconstructed ligaments can be as strong as the original ones, but they may not have the same properties. The risk of re-injury can depend on various factors, including the type of graft used, adherence to rehabilitation protocols, and the level of activity post-surgery. Many athletes return to their pre-injury performance levels after proper rehabilitation, but it’s essential to follow your surgeon's advice and gradually increase activity levels.

In conclusion, your concerns about the upcoming surgeries are valid, and it’s essential to have open communication with your healthcare team. Make sure to ask them about their recommendations, the rationale behind their decisions, and any other concerns you may have. Your recovery and return to sports will depend significantly on the quality of the surgical procedure and your commitment to rehabilitation. Good luck with your surgery and recovery!

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