Knee: Ligament Reconstruction

Ligamentous knee injuries are common across all levels of sport, and if untreated, they can lead to chronic instability, damage to the articular cartilage and menisci, and eventually premature osteoarthritis. The anterior cruciate ligament is the most commonly reconstructed ligament in the knee; however increasing numbers of surgeries to other ligaments, including the posterior cruciate ligament, collateral ligaments and posterolateral corner structures, are being performed as more is learned about how ligamentous injury alters the biomechanics of the knee. The majority of patients achieve excellent outcomes following surgery; however some patients present with ongoing symptoms requiring imaging investigation, such as persisting instability, reduced range of movement and pain. Post-operative imaging typically involves a combination of conventional radiographs, computed tomography and magnetic resonance imaging to provide detailed evaluation of the ligament graft or repair, bone tunnels, hardware and donor site. A detailed understanding of the expected imaging findings across all imaging modalities for the commonly performed procedures is essential when interpreting post-operative imaging, as is a knowledge of the abnormal findings associated with complications and ultimately failure. This chapter reviews the advances in the surgical techniques used to treat sporting ligamentous knee injuries and describes both the expected normal post-operative imaging appearances and those of the commonly encountered complications.