Anterolateral Ligament Reconstruction (Knee)

What is Anterolateral Ligament Reconstruction?

Anterolateral ligament reconstruction is a surgical procedure to reconstruct and repair a damaged anterolateral ligament located on the outside of the knee.

Anatomy of Anterolateral Ligament Reconstruction

Anterolateral ligament (ALL) is a group of tissue that extends from the lower part of the femur (thigh bone) to the upper and outer part of the tibia (shin bone). This ligament provides rotational stability during the movement of the knee joint.

Indications for Anterolateral Ligament Reconstruction

Anterolateral ligament reconstruction is mainly indicated when the ligament is severely damaged due to:

• Sports injury
• Automobile accident
• Forceful twisting
• High Impact Injury
• Fall from heights

Preparation for Anterolateral Ligament Reconstruction

In preparation for anterolateral ligament reconstruction surgery, you are generally required to:

• Inform your doctor of your past medical history including medications or supplements and allergies. 
• Discontinue certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two. 
• Refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process. 
• Stop consuming any solids or liquids 8 hours prior to surgery.
• Arrange for someone to drive you home after surgery.

Anterolateral Ligament Reconstruction Procedure

The anterolateral ligament reconstruction procedure may involve the following steps: 

• You are placed in the supine position.
• General or local anaesthesia may be administered.
• Small incisions are made on the outside of the knee over the tibia and femur. 
• The fascia that overlies the Iliotibial band (ITB) is dissected and holes are drilled into the bones. 
• A special path is made using a blunt dissection below the superficial layer of the ITB.
• The placement of the graft is determined by extending and flexing the leg. 
• The graft may be taken from the hamstring tendon in the back of the leg. 
• The graft is folded to the desired length and inserted into the tunnels made in the bone. 
• The graft is fixed with a fixation device and the knee is then assessed for its stability and range of motion.

Postoperative Care after Anterolateral Ligament Reconstruction

The postoperative care recovery after anterolateral ligament reconstruction surgery may involve the following:

• You are transferred to the recovery area and observed for any allergic or anaesthetic reactions and your vital signs will be monitored.
• You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed to keep you comfortable.
• You are advised to keep your leg elevated while resting to prevent swelling and pain.
• You will be advised on use of assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• A gradual increase in activities is recommended with avoidance of strenuous activities and heavy lifting for the first few months.

Risks and Complications of Anterolateral Ligament Reconstruction

Anterolateral ligament reconstruction surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Pain and weakness in the knee
• Adverse reactions to anaesthesia
• Blood clot or deep vein thrombosis
• Damage to adjacent soft tissue structures
• Stiffness or decreased range of motion
• Rupture of the graft