ligaments repair

Anatomically, ligament is a fibrous band connecting two bones.  Physiologically however ligaments are actually invested with many nerve endings.  Hence from a functional point of view, it is working as a “mechanoreceptor”.  This means that forces are sensed and these senses are used to coordinate neuromuscular activity.  This is usually done subconsciously as in a healthy situation movement is normally natural and a familiar or pattern process.  This is in contrast to patients who have lost ligament function who sense instability and do not trust the knee particularly with pivoting.  This can lead to recurrent episodes of giving way that can result in damaging the internal surface of the knee.

The ligaments can be injured in isolation or in combination with other soft tissue or bony injuries.

ligament repair

The Cruciates

The cruciates are strong ligaments in the centre of the knee.  They have reciprocal attachments on the thigh and shinbone and hence tend to cross in the centre of the knee.

The ligament arising from the anterior part of the tibia is called the anterior cruciate ligament.  Both ligaments help limit excessive forward and backward movements of the shinbone relative to the thighbone.  The cruciates and in particular the anterior cruciate is very important with regards pivoting, side stepping or sudden changes in direction.

Some injuries can occur with direct contact and others by non-contact twisting.  Patients may report hearing a crack or having a sudden swelling of the knee.  The posterior cruciate is a much larger ligament and injured with direct blows to the lower leg or in combination with other injuries.

The loss of cruciate ligament function may be partial isolated and compensated by activity modification and good quality physiotherapy.

However some patients <UNCLEAR 10:46> or in a position to modify their activities will continue to have instability despite full compliance and a good rehabilitation programme.


To date good repair of the anterior cruciate ligament has not been successful.  There are exceptions in children who are more likely to have a bony pull-off or avulsion type injuries.

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