The knee joint is supported by four main ligaments: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL), and the medial collateral ligament (MCL). Injuries to one or more of these ligaments can occur due to trauma. Treatment varies depending on which ligament is injured and the extent of the injury and may involve either non-surgical or surgical approaches. Even when surgery is necessary, pre-operative physiotherapy and rehabilitation are often recommended to optimise the patient’s condition before the procedure.

Anterior Cruciate Ligament (ACL)

The ACL stabilises the knee joint by preventing the tibia (lower leg bone) from moving too far forward during knee movement. An ACL injury can cause the knee to feel unstable and may result in it giving way, particularly during running or activities requiring quick changes of direction.

Most active patients with an ACL tear will require surgery. During the procedure, the patient’s own hamstring tendons or patellar (kneecap) tendon is used to reconstruct the torn ACL. The choice of tendon is personalised to each patient. Dr Arakkal prefers using the patient’s own tendons, as scientific evidence suggests that donor or artificial tendons don’t perform as well in ACL surgery.

The surgery is performed using keyhole (arthroscopic) techniques, with very small incisions made around the knee. Cameras and instruments are then inserted to reconstruct the torn ACL.

Watch video of Multiligament Knee Reconstruction

Posterior Cruciate Ligament (PCL)

The PCL stabilises the knee by preventing the tibia from moving too far backward during knee movement. A PCL injury can also cause the knee to feel unstable and may result in it giving way during activities such as running or rapid direction changes. Depending on the severity of the injury, PCL injuries can be treated non-surgically with a brace and an intensive rehabilitation programme or surgically. During surgery, the patient’s own hamstring tendons or artificial tendons are used to reconstruct the torn PCL, with the choice tailored to each patient. As with ACL surgery, keyhole techniques are used to reconstruct the ligament.

Medial Collateral Ligament (MCL)

The MCL helps stabilise the knee by keeping the tibia attached to the femur (thigh bone) during knee movement. It is located on the inner side of the knee. An MCL injury can cause the knee to feel unstable and may lead to it giving way. MCL injuries can be treated non-surgically with a brace and an intensive rehabilitation programme or surgically, depending on the injury type. During surgery, the patient’s own tendons or artificial tendons may be used to reconstruct the MCL. The new tendon is then carefully attached to the femur and tibia to restore stability.

Lateral Collateral Ligament (LCL)

The LCL stabilises the knee by keeping the tibia attached to the femur during knee movement. It is located on the outer side of the knee. An LCL injury can cause instability in the knee, leading to it giving way. Surgical reconstruction of the LCL involves using the patient’s own tendons or artificial tendons, with the choice tailored to each patient. The new tendon is carefully attached to the femur and tibia to restore the function of the ligament.

Rehabilitation After Knee Ligament Surgery

Rehabilitation is crucial following knee ligament surgery. A specially tailored rehabilitation programme is provided to each patient to optimise their recovery. The rehabilitation is conducted by physiotherapists and, in some cases, biokineticists under the guidance of the treating orthopaedic surgeon.