How Torn Ligaments - Like Marcus Lattimore's - are Repaired
Since the game, it has been reported that Lattimore suffered a severe dislocation and damage to several of the ligaments in his knee. Doctors, coaches and fans are optimistic that Lattimore can battle back to play again, but just how do ligament injuries like this get repaired? Sports Medicine surgeon Shay Koch, MD clues us in:
"Injuries like Marcus Lattimore's are obviously severe and do not happen to the average person," Dr. Koch says. "Injuries like his can involve damage to surrounding blood vessels and nerves in addition to the knee ligaments. However, the process for reconstructing those damaged ligaments - for the most part - is the same for athletes and non-athletes alike."
Ligaments are tough, rope-like fibers that connect one bone to another. The four main ligaments of the knee connect the upper leg bone (femur) to the lower leg bone (tibia) and stabilize knee movement.
The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) cross inside the center of the knee joint and stabilize front-to-back knee movements.
The medial collateral ligament (MCL) and the lateral collateral ligament (LCL) connect the leg bones at the sides of the knee and stabilize side-to-side movements.
Prepping the Knee
"When a ligament is damaged, a significant amount of swelling and stiffness can occur in the knee joint," Dr. Koch says. "In cases in which swelling affects range of motion and surgery is needed, one may need to wait to have surgery until after regaining leg strength and knee motion. This will help treatment be more successful and can decrease post-operative knee stiffness." Rest, icing and using physical therapy can get the injured knee in the best condition for surgery, as can following your doctor's instructions for taking over-the-counter or prescription-strength anti-inflammatory medications.
Repairing the Damage
Reconstruction of ACL and PCL ligaments are generally done arthroscopically, which means minimally-invasive tools are used to see inside the joint and repair the damage. Ligaments outside the knee joint, the MCL and LCL, are normally reconstructed with an open approach.
"Most torn ligaments cannot be repaired," Dr. Koch says. "Instead, they must be reconstructed using tendons." The patient's own patellar tendon, quadriceps tendon or hamstring can be used, as well as a piece of donor tissue depending on both patient and surgeon preference.
Once the tendon is harvested, the damaged ligament is partially removed. Then the harvested tissue is attached to long sutures and pulled into place through small holes that the surgeon makes in the knee. "The tendon tissue is held in place with devices like screws or buttons while the tendon heals into the bone," Dr. Koch says. "These devices typically do not need to be removed, and some are even absorbed by the body." Once the surgeon decides the knee is sufficiently stable, the knee is closed and dressed.
Watch Sports Medicine Surgeon Dr. Baumgarten perform an ACL surgery!
Right after surgery, crutches and braces may be used to provide stability while muscle strength returns. In some cases where multiple ligaments are injured weight bearing may also be restricted for several weeks. Physical therapy is an essential part of the treatment plan, with the first session ideally occurring within a day or two of surgery. Early, appropriately aggressive therapy helps return to full function quickly, and may decrease the chance of complications after surgery.