Causes of ligament re-rupture after surgery

Master, Doctor, CKII Tran Anh Vu, Head of Sports Medicine and Endoscopy Department, Orthopedic Trauma Center, Tam Anh General Hospital, Ho Chi Minh City, said that normally the failure rate in ligament surgery ranges from 5-20% depending on each case and specific surgical technique. In cases of multiple ligament ruptures, the recovery rate after treatment is slower and the risk of re-rupture is higher.

“The causes of failure after ligament replacement surgery can be objective or subjective,” said Dr. Vu, giving an example of people with a joint structure with a wide tibial tunnel, a lot of ligament swing, which can easily cause tension overload, and the surgical technique and ligament material used do not ensure high efficiency. Patients with surgical infections, previous ligament surgery… can also cause the surgery to fail.

Other causes after surgery include patients not following the rehabilitation program properly; returning to work, playing sports too soon or with too much intensity. Poor nutrition, obesity, increased pressure on the joints, and smoking also contribute to a higher failure rate of cruciate ligament surgery.

Dr. Vu said that in the first 4 months of the year, Tam Anh General Hospital received 500 visits due to ligament injuries, of which about 20% were re-ruptured ligaments. The main causes were returning to sports too soon or falling when the ligament had not yet recovered from the previous surgery.

Like Mr. Nam, 42 years old, tore his anterior cruciate ligament while playing soccer and had surgery to reconstruct the ligament using autologous tendon. During daily activities, the ligament continued to stretch and tear, but he did not seek treatment until his muscles atrophied severely, with only about 40% of his right thigh muscle remaining compared to his left leg.

In the second surgery, the patient was reconstructed with an artificial ligament. However, due to severe atrophy of the thigh muscles, the ligament had to bear excessive force to support the activities of the knee joint. Therefore, during a fall, Mr. Nam continued to tear the ligament and had to undergo a third reconstruction surgery with an artificial ligament.

In another case, Mr. Long, 37 years old, had surgery to reconstruct the anterior cruciate ligament using autologous tendon. He returned to sports early, causing the ligament to re-rupture but without treatment, causing persistent knee pain and difficulty walking for 6 years. The rupture of the ligament left untreated for a long time caused meniscus tear, knee instability, effusion and mild degeneration. At this time, Mr. Long decided to have surgery again using autologous tendon.

According to Dr. Vu, both cases above had their ligaments reconstructed a third time using the all inside technique. This is a minimally invasive endoscopic method, which helps limit the risk of bleeding, minimize soft tissue damage, and shorten recovery time. Other injuries to the body (if any) are also treated in the same surgery.

With modern ligament replacement surgery techniques, patients can walk early on the first day after surgery. However, Dr. Vu warned that the new ligament has not yet fully recovered. In all cases, the body needs enough time to produce fibrous tissue to repair the damage. During this time, patients need to follow the doctor’s instructions in daily activities, especially rehabilitation exercises.

Rehabilitation exercises not only strengthen ligaments but also improve muscle strength, cartilage, etc. so that the knee joint can move smoothly. Patients need to strictly follow the exercise program for about 2-6 months in different stages, depending on the type of ligament being reconstructed, and should not rush back to playing sports.

Dr. Vu said that rehabilitation exercises, including both pre- and post-surgery, are an indispensable part of the treatment regimen. Depending on the condition, the patient has a separate training schedule. Patients are assessed for injuries, closely monitored for recovery using the Dyneelax ligament assessment robot, trained with modern equipment and assessed for lower limb strength… The combination of surgical methods and personalized rehabilitation exercises helps patients recover faster.

Depending on the type of ligament and the reconstruction technique, patients can return to sports after 6 months to a year. To avoid re-rupture, patients need to strictly follow the rehabilitation process. Each person should listen to their body, have regular check-ups, and only return to sports when the doctor agrees.