Advances in knee surgery and rehabilitation: ligament reconstruction and prosthesis
This lecture explores modern approaches to knee surgery, including ligament reconstruction and knee replacement. Dr. Morgado presents current surgical techniques, while Dr. Muff details postoperative rehabilitation and return to sport. The emphasis is on personalized treatment and interdisciplinary collaboration.
Doctors
Topics
Treatments
Advice
- Dr. Sylvia Morgado Piçarra; Dr. Guillaume Muff
- Introduction Medicol
- ACL Surgery
- Pre-operative preparation
- Ligamentoplasty techniques
- Meniscus repair
- Ligamentoplasty
- Total knee replacement
- Functional rehabilitation
- prepare the knee before surgery
- adapt rehabilitation to the patient
- delay returning to sport
- analyze the patient's expectations
- personalized follow-up
Ligamentoplasty and knee replacement: issues, objectives and coordination of care
The knee is a complex weight-bearing joint. When an anterior cruciate ligament (ACL) is torn or gonarthrosis sets in, stability and function deteriorate; pain, apprehension, and decreased performance disrupt daily life and sporting activities. In this context, the primary objective is twofold: to restore a stable, pain-free joint, and to enable a safe return to the intended activities.
Given the particularly active Swiss population, ligament injuries and knee osteoarthritis are a common reason for consultation. Modern care combines rational surgical intervention (ligamentoplasty, osteotomy, partial or total knee replacement) with high-quality, early-stage rehabilitation. The key message remains personalization: each patient has a specific history, expectations, and biomechanics.
Thus, success depends on a controlled sequence: clear information, preoperative preparation, appropriate surgical technique, and rigorous functional monitoring. Close coordination between orthopedic surgeons, sports physicians, anesthesiologists, and physiotherapists ensures continuity of care and progress in measurable stages, helping the knee regain stability and confidence.
ACL rupture: therapeutic decision and preoperative preparation
Ligamentoplasty is now the gold standard when instability compromises function, particularly in active patients. Emergency surgery remains the exception (bucket handle meniscal tear; associated repair). In the majority of situations, preoperative preparation is crucial: a pain-free knee, full mobility, and satisfactory muscle strength determine the results. This phase includes therapeutic education, pain management, and targeted muscle reactivation.
Intraoperatively, anatomical reconstruction of the ACL is associated with the treatment of concomitant lesions: repair of the posteromedial ramps, refixation of meniscal root avulsions, and, depending on the rotational instability profiles, lateral reinforcement or action on the anterolateral ligament. Morphological factors must be assessed (marked varus, increased tibial slope), which may lead to an additional osteotomy when the constraint prevents the plasty from working.
Finally, certain functional determinants at a distance from the knee interfere with the injury mechanism: a functional hallux limitus can promote a pronation-valgus-internal rotation sequence during changes of support. Global biomechanical analysis and adaptation of techniques aim to reduce the risk of recurrence and to preserve meniscal and cartilage capital in the long term.
The risk of post-traumatic osteoarthritis remains high after an ACL tear.
Rehabilitation after ligament reconstruction: phases, criteria and return to sport
Rehabilitation begins early around three axes: pain and effusion control (notably by cryotherapy), mobility recovery (in compliance with surgical instructions) and quadriceps reactivation followed by progressive strengthening with neuromuscular and proprioceptive work. Adjuvants can be considered depending on the patient's condition: electrostimulation if necessary, flow restriction training (BFR) to stimulate hypertrophy under low loads, and regular functional tests to adjust the load.
Return to sport is a step-by-step process: participation, resumption of activity, and then return to performance. Decisions combine biological healing time, objective criteria (strength symmetry, jump tests, neuromuscular control, absence of flexion contracture), and psychological status. Recent data suggest avoiding a competitive return before the 8th month; each month gained beyond this reduces the risk of reinjury, provided defined functional milestones are reached.
The aim is to achieve a sustainable and safe recovery, while protecting the meniscus and cartilage. The quality of follow-up, patient compliance, and consistency of messages from the healthcare team determine the stability restored and confidence in the reconstructed knee.
Gonarthrosis and prosthetic surgery: expectations, techniques and satisfaction
In advanced osteoarthritis, the surgical indication is based on clinical findings, long-leg radiographs, and a thorough discussion of expectations. Unicompartmental and total prostheses have benefited from innovations: 3D planning, personalized cutting guides, navigation, and robotics improve positioning accuracy. To date, the long-term functional benefit of these technologies, compared to conventional instruments, remains under evaluation; alignment tends toward measured customization to respect the anatomy without over-constraining the implant.
Current protocols combine tissue protection, multimodal analgesics, and perioperative optimization (adductor canal block, tranexamic acid, early ambulation). Despite this, a significant proportion of patients remain dissatisfied after total knee replacement; the key lies in honest preoperative information, the definition of realistic objectives, and support to help the patient integrate their prosthetic knee into the body schema.
Clinical examination, active listening and structured follow-up promote progressive adaptation, targeting residual pain, mobility and confidence during daily living and leisure activities.
The patient must adapt to his prosthetic knee; it must become his knee.
Interdisciplinary support and personalized monitoring
Success depends on a seamless inter-specialty organization. The surgeon defines the indication and technical strategy, the sports medicine physician coordinates functional progression, and the physiotherapist guides the graduated exposure to load and movement complexity. Preoperative therapeutic education reduces anxiety, often shortens immediate convalescence, and improves adherence to instructions, although the magnitude of the effect varies depending on the profile.
Contemporary tools complement the treatment when it makes sense: telerehabilitation and virtual reality offer additional exposure and adherence monitoring, in a secure setting. The common thread remains progressiveness: stabilized pain, regained full extension, symmetry of dynamic strength and control before any sporting objective. Specific situations (driving, physical occupations) are addressed on a case-by-case basis, with the same principle of safety first.
Perspectives and key messages for the patient
After an ACL tear, preventing recurrence and protecting meniscal capital are central. A structured program of strengthening, balance, and weight-bearing control, combined with appropriate surgical techniques when indicated, reduces the risk of secondary destabilization and cartilage degradation. In the longer term, lifestyle factors (weight, smoking, training load management) contribute to knee health.
In osteoarthritis, prosthesis is not an end in itself but a means: the challenge is to restore reliable function, compatible with expectations, through precise planning and rigorous rehabilitation. Prevention remains a major lever: warm-up, physical preparation and movement education, particularly in pivot sports, help limit injuries. A clear and continuous alliance with the healthcare team allows you to move forward calmly, step by step.
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