The knee joint is one of the synovial joints present in the body. A pair of long bones are articulated against one another, separated by a capsular ligament and articular cartilage. Like any mechanical component, the joint is prone to wear and tear depending upon its use or abuse, especially with sports and athletics, as well as old age and arthritis. This article discusses the injuries to one of the principal knee ligaments, known as the anterior cruciate ligament (ACL), the type of treatments done, and the potential risks and possible chances of its recurrence.

Knee reconstruction surgeries have been in vogue since the early 1970s. The technique has been perfected and modernized over the years to provide for minimal surgical dissection and longer-lasting implants to improve the quality of life for patients as a whole.

What Are the Components of the Knee Joint?

The knee joint consists of three main bony components and an array of ligaments, cartilage, blood, nerve, and muscle supply. The components can be sub-classified as follows;

1. Bony Components.

The thigh bone or femur.
The shin bone or tibia.
The kneecap or patella.

2. Ligaments.

Anterior cruciate ligament.
Posterior cruciate ligament.
Medial collateral ligament.
Lateral collateral ligament.

3. Cartilage.

When Does Knee Pain Occur?

The knee joint is among the most used parts of the body, prone to heavy stress and wear and tear for decades. The quality of the bone and the nature of the exertions subjected to it cause significant stress to its components, resulting in a wide array of problems leading to knee pain. The common causes behind this are;

Tear in the ligaments.
Arthritis or inflammation of the joints.
Tear of cartilage meniscus.
Loss of blood supply to the bone.
Trauma or injury to the joint.
Increased body weight.
Fracture of the joint.
Infections.
Repetitive strain or common overuse.

When to Consult a Specialist?

Knee pain is the principal cause for patients turning up to consult specialists in the field. Other symptoms may include;

Crackling sounds.
Discomfort while performing menial tasks like walking, climbing stairs, or getting up from a chair.
Swelling of the joints, which is not relieved by medication.
Locking of the joints.
Instability of the joint.
Loss of range of motion.
Stiffness.
Bow-legged knee deformity.

How Is It Diagnosed?

After taking clinical and personal history, the specialist conducts a local physical examination of the affected areas, followed by medical imaging such as X-rays, magnetic resonance imaging (MRI) scans, and computed tomography (CT) scans to identify the location of the underlying pathology. The treatment plan is then devised accordingly.

How Is It Treated?

Treatment plans depend upon the extent of the damage to the joint and may warrant one of the following procedures;

Ligament reconstruction.
Partial knee replacement.
Total knee replacement.

How Are Knee Surgeries Performed?

Knee surgeries are typically performed either under general or spinal anesthesia. First, an incision is made on the affected joint's surface skin. The damaged portion of the bone or cartilage is then removed, and suitable grooves are created to house the implants necessary. Following this, the implants are stabilized using either screw plates or cement. A plastic liner insert is placed between the two articulating bone surfaces to act as the cartilage.

In the case of ligament reconstruction surgeries, the hamstring tendon is used as a graft, coupled with drilling holes in appropriate places of the knee joint surfaces, then pulled through it. This is followed by stabilization, using screws or plates, and suturing to allow healing of the cartilage into the bone.

How Is Rehabilitation Done Postoperatively?

Rehabilitation postoperatively follows almost immediately. A physical therapist is appointed to train the patient with suitable exercises to help strengthen the joint to somewhat original capacity and restore adequate knee movements. Prosthetic devices such as a walker, crutches, or cane may be prescribed for a while until the joint regains its functionality. A continuous passive motion (CPM) machine may passively move the joint while the patient relaxes. An exercise program at home will also be prescribed to keep joint functionality intact.

What Are the Postoperative Complications?

Infection of the operative site.
Knee stiffness.
Blood clots (deep vein thrombosis).
Damage to nerve and blood vessels.
Implant loosening.
Wearing out of plastic liners.
Kneecap dislocation.
Injury to ligaments.
Addiction to narcotic pain relief medication is usually provided short-term.

What to Do at Home?

Surgical efficiency, however perfect, must be complemented with adequate home care for the patient during and after the recovery phase. The safeguards and measures taken at home can be as follows;

Create a living space restricted to one floor at home.
Install guard rails and handles wherever needed, such as in showers and stairways.
Stable chair with cushion and footstool to elevate the joint.
Arrange for a toilet seat riser with handles if the toilet height is short.
Remove loose rugs and cords.

What Is the Rate of Success?

For most patients, knee reconstruction provides pain relief and improved quality of life for over 10 to 15 years, provided no debilitating postoperative complications crop up. Bed-rest of three to four weeks also may allow for easier discharge of menial tasks such as walking up an incline or driving. However, repetitive strain such as athletic activities like swimming, jogging, and running should be avoided.

Conclusion

Knee reconstruction is considered a somewhat risk-free surgical procedure intended to eliminate knee pain, damaged tissue, and reconstruction of injured ligaments from repetitive strain and overuse. Recovery usually takes a few weeks with certain precautions, occupational therapy, and pain management. Care must be taken to prevent addiction to opioids prescribed for pain management.