Knowing your Knee Ligaments
When we speak about knee ligament tears, it is important to know that there are four main ligaments in the knee that commonly get injured.
- the Anterior Cruciate Ligament(ACL)
- This ligament is the most frequently injured ligament
- the Posterior Cruciate Ligament(PCL)
- the Lateral Collateral Ligament(LCL)
- the Medial Collateral Ligament(MCL)
What is a Knee Ligament Tear Surgery?
Depending on the severity of the injury, plus other factors such as urgency, your sports injury doctor upon assessment might or might not recommend that you go for ligament tear surgery. Usually, your doctor will try to push conservative treatment methods first, such as rest and medications. If those treatment options fail to meaningfully aid you, then surgery will be advised. Surgery for knee ligament tears usually involve reconstructing or repairing the aforementioned ligament.
Knee ligament tear surgery uses a graft to replace the damaged ligament. The most common grafts are obtained from parts of your own body, such as the tendon of the kneecap or one of the hamstring tendons. You can also receive a graft from a cadaver, but if you are uncomfortable with it, do let your doctor know.
Knee ligament repair surgery is used only in the case of an avulsion fracture(where the ligament is still attached to the bone, but the bone has broken off). Such situations warrant a repair surgery where the broken bone is attached back to the main bone.
Knee ligament tear surgery can be conducted either through arthroscopic surgeries or open surgeries. Arthroscopic surgeries are preferred due to the small incision size, which results in fewer complications.
What are Arthroscopic Surgeries?
An arthroscopic surgery is where small incisions are made, and the surgery is carried out with the help of a camera. As mentioned above, this method is preferred by almost every sports injury doctor due to the lesser risks involved.
What are Open Surgeries?
An open surgery is like the ‘traditional’ surgery where a large incision is made.
Risks ligament tear surgery
As with any form of surgery, there are risks involved that you need to be aware of, and are required to discuss with your doctor before proceeding with the surgery:
- In the case of an ACL tear, ACL surgery fully restores the functioning of the knee in 80% of cases
- Your knee may still have pain and swelling after the surgery
- Your knee may not be exactly like it was before the injury
- There may be other injuries other than a ligament tear that may have occurred
- Infection, blood clots, knee pain, knee weakness and stiffness may occur after the surgery
- There is a small chance(less than 10%) that the newly grafted ligament will fail. This is usually followed up with further surgical measures
What to expect from a ligament tear surgery
- There is usually a recovery period of 6 months after surgery, but it usually takes even longer(about a year) to return back to competitive sport
- You may still experience slight instability initially, this may or may not resolve itself, but it usually does after 6 months
- It is essential that you keep the wound clean at all times. You will receive special instructions from your sports injury doctor on how to bathe and dress your wound
- If there is inflammation and swelling, take the NSAIDs that you were prescribed to lessen the inflammation
- It is essential that you attend your physiotherapy sessions to ensure full recovery from a knee ligament tear. Failing to adhere to your appointments may result in an incomplete range of motion after your injury has fully healed
- Try to avoid falls and direct pressure being applied to the site of injury, as it may result in the ligament tearing again.
Sports Injury Doctor – Private or Government?
Seeking help from either private or public medical facilities has numerous advantages and disadvantages on both sides. For the most part, private clinics in Singapore clearly offer better service, higher expertise and definitely a much shorter waiting time.
The only downside is the costs, which can be much higher than government hospitals like SGH or NUH. However, many orthopedic surgeries are actually insurance claimable and costs can go down significantly. Most private clinics don’t tell you that though, but some like HC Ortho actually advise on medical insurance claims and even have a top orthopedic name in Dr Henry Chan who is very experienced in ligament tear surgeries.
Government hospitals are often also an often, if for the sheer affordability. However, long waiting times can be often unbearable when you are suffering from something as painful and serious as a ligament tear. If your pain tolerance is high or if your job is sedentary (like office seated jobs), you can possibly try government clinics. Try not to drag longer than 1-2 months if possible.