You Put Your Left Knee In . . .It's hard enough when one knee is injured, but imagine having both knees out of order. Life gets tricky. So does treatment. Most people with knee problems from anterior cruciate ligament (ACL) tears use a rehab program or surgery to get better. These cases get complicated when a second or third injury affects both knees.
In patients like these, doctors look at all the options. They try and decide which treatment works best for each patient. Symptoms such as pain, loss of motion, and weakness help guide the decision. Treatment may take place in stages. First, exercise and rehab are tried. If these don't work, surgery becomes an option. If surgery is done on one knee first and then the other knee, it is called a staged procedure.
There are many different ways to do this surgery. A piece of tendon from the left knee can be used to repair the right knee. Or the replacement tendon could come from the same knee. It may come from one of two places around the knee: the tendon to the kneecap or the tendon to the hamstring muscle in back of the knee. Another option is to use a piece of tendon donated by someone else (called an allograft).
All of these choices must be looked at carefully. There are good things and bad things about each one. For example, when an allograft is used, a second incision for a "donor site" is not needed.
for the patient. This prevents problems such as infection or poor healing at the donor site. However, there can still be infection, disease, or loss of blood supply when the donated tendon is in place.
In the case of one 28-year old woman, surgery was needed despite a strong rehab program to strengthen both knees. Her knees were weak and unable to support her. The doctors did surgery on the weaker (left) leg first. They used a piece of tendon from the right knee to reconstruct the left ACL.
Six months later, the second stage was done with ACL surgery on the right knee. Again, the doctors took a tendon from the opposite (left) knee to repair the right ACL. A rehab program before and after both surgeries was followed with very good results in both knees. The patient was able to exercise regularly without knee braces.
Sanjiv Jari, MBChB, FRCS, FRCS [TR & Orth], and K. Donald Shelbourne, MD. Staged Bilateral Anterior Cruciate Ligament Reconstruction with Use of Contralateral Patellar Tendon Autograft: A Case Report. In The American Journal of Sports Medicine. May/June 2002. Vol. 30. No. 3. Pp. 437-440.
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