DR. ONG KEE LEONG
Revision Knee Ligament Reconstruction/Replacement
Revision knee ligament reconstruction/replacement is a surgical procedure that repairs or replaces previously reconstructed knee ligaments that have not healed properly or have become damaged again. When an initial knee ligament surgery does not fully resolve instability or pain, this follow-up procedure may be recommended. The goal is to restore stability to the knee, reduce pain, and help you return to normal activities.
Book AppointmentPotential Risks and Complications
Revision knee ligament reconstruction involves certain risks beyond those of first-time surgery. These include infection at the surgical site, blood clots in leg veins, and a higher chance of graft failure. Some patients may experience ongoing stiffness or limited motion despite rehabilitation. Nerve or blood vessel damage during surgery is rare but possible. Hardware problems such as irritation from fixation devices may require removal. Achieving full knee stability can be more challenging in revision cases, with some patients experiencing mild ongoing looseness even after technically successful surgery.
Indications for the Procedure
Several conditions may suggest that a revision knee procedure would be beneficial for a patient.
- Failed Primary Reconstruction: The original repair has stretched, torn, or not healed as expected. You may notice your knee giving way or feeling unstable when walking or standing up from a chair.
- Persistent Instability: Despite having had surgery and rehabilitation, your knee still feels wobbly or unreliable. This ongoing instability may cause you to avoid certain activities or make you feel unsteady when walking on uneven surfaces.
- Improper Tunnel Placement: The channels drilled in the bone during the first surgery were not positioned correctly. This can cause the replacement ligament to work ineffectively, leading to continued pain or instability.
- Graft Material Problems: The tissue used in the previous surgery has broken down or failed. Sometimes artificial or donor tissue grafts can wear out over time or cause reactions that affect knee function.
- New Injury: A subsequent accident or fall has damaged the previously reconstructed ligament. Even a minor twist or direct hit to the knee can sometimes compromise a reconstructed ligament.
Benefits of the Procedure
Revision knee ligament surgery offers several advantages for patients who continue to have problems after their initial surgery.
- Restored Stability: The procedure fixes the knee’s ability to function without giving way during activities. You will be able to walk, climb stairs, and move without the knee suddenly buckling or feeling unsteady.
- Pain Reduction: Fixing the underlying ligament issue helps decrease discomfort associated with knee instability. Many patients report less pain with movement and during daily activities after successful revision surgery.
- Improved Function: Patients typically gain better movement and strength in the affected knee. Activities that were difficult or impossible because of knee instability often become manageable again after recovery.
- Prevention of Secondary Damage: A stable knee helps protect cartilage and other knee structures from wearing out prematurely. Unstable knees tend to develop early arthritis and further damage if not properly treated.
Surgical Techniques
Single-Stage Revision
The entire repair is done in one operation. The surgeon removes the failed ligament, addresses any bone tunnel problems, and places a new graft all during the same surgery. This approach works well when the bone quality is good and only minor bone repairs are needed.
Two-Stage Revision
The repair is split into two separate surgeries several months apart. The first stage removes the failed graft and fills any enlarged bone tunnels with bone graft material. After 6 months, when the bone has healed, a second surgery places the new ligament graft. A CT scan is often performed to confirm that the bone has healed. This approach is used when significant bone healing is needed before the new ligament can be attached.
Extra-articular Augmentation
This technique adds support structures outside the main knee joint. In addition to replacing the main ligament inside the knee, the surgeon adds extra tissue reinforcement on the outer part of the knee. This provides additional stability, especially for knees that have problems with rotational movements.
Medisave & Insurance Shield Plan Approved
For Singaporeans & Singapore Permanent Residents
Preparing for the Procedure
- Medical Evaluation: A thorough health assessment is necessary before scheduling surgery. This includes blood tests and possibly heart evaluations to ensure fitness for the procedure. Conditions such as diabetes or heart disease require careful management beforehand.
- Imaging Studies: Various scans help plan the specific approach needed for the knee. MRI scans show the condition of the failed ligament and other knee structures, while CT scans may examine the bone tunnels from previous surgery. These images help create a personalised surgical plan.
- Medication Adjustments: Some medicines need to be temporarily stopped before surgery to reduce bleeding risk. Blood thinners such as aspirin, warfarin, or clopidogrel usually require discontinuation 5-7 days before surgery, but only under medical supervision. Anti-inflammatory medications may also need to be paused 1-2 weeks before the procedure.
Post-Surgical Care and Recovery
- Early Recovery: In the first few weeks after surgery, the focus is on managing pain, reducing swelling with ice, and protecting the knee. The knee will be immobilised in a brace with weight-bearing restrictions. Gentle exercises begin to prevent stiffness, including simple bending and straightening of the knee. Physical therapy usually begins within the first week.
- Rehabilitation Phase: From weeks 4 through month 9, rehabilitation gradually progresses from basic strengthening to more advanced functional exercises. The initial focus is on rebuilding muscle strength and stability with gradually increasing weight-bearing activities. Later, exercises evolve to include movements specific to daily activities, work, or sports. Running on flat surfaces may begin around month 4-5, while activities involving quick turns are introduced based on individual progress.
- Follow-up Care: Periodic check-ups evaluate the knee’s stability, strength, and function throughout the recovery journey. These assessments determine readiness to return to full activities, typically 12 months after surgery, though timelines vary for each person.
Step-by-Step Procedure
Anaesthesia and Initial Assessment
The procedure begins with administering anaesthesia. Once proper sedation is achieved, the inside of the knee is examined using a small camera inserted through tiny incisions, allowing assessment of the failed graft and other structures.
Graft and Tunnel Management
The damaged ligament and hardware from the previous surgery are removed, followed by evaluation and preparation of the bone tunnels. Depending on their condition, expanded tunnels may need filling with bone graft or new tunnels may be created in the shin bone (tibia) and thigh bone (femur).
New Graft Placement
A suitable replacement tissue is selected, either from the patient’s own body (autograft) or from a donor (allograft). This new ligament graft is carefully positioned through the prepared tunnels and secured with fixation devices to ensure proper tension and stability.
Completion
After confirming proper placement and knee stability, all incisions are closed with stitches and sterile dressings are applied. A supportive brace may be fitted to protect the knee during initial healing.
Why Do Patients Choose Dr Ong Kee Leong?
- Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
- Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
- Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
- Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
- Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
- Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
- Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
- Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park Hospital
- Minimal Waiting Time For Initial Consultation
- Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)
About Dr. Ong Kee Leong
Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)
Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.
He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.
- MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
- Member of the Royal College of Surgeons of Edinburgh 2007
- Master of Medicine in Orthopaedic Surgery (NUS) 2007
- Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
- Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
- Sports Surgery and Arthroscopy in Germany (Hannover)
- Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
- Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
- Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
- He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
- Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
- He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.
Frequently Asked Questions
Is revision surgery more complex than the original reconstruction?
Yes, revision surgery faces additional challenges, including dealing with enlarged bone tunnels, removing previous hardware, working through scar tissue, and possibly needing bone grafting. The procedure usually takes longer than the original surgery and may require specialised techniques to achieve good stability.
How long will I need to take off work after revision knee ligament surgery?
Return to work timing depends on your job requirements. For desk jobs, you may return within 1-2 weeks using crutches or a brace. Jobs requiring standing or walking typically need 6 weeks off. Physically demanding jobs involving lifting, climbing, or heavy labour usually require 3-6 months before full return.
Can I return to sports after revision surgery?
Many patients can return to sports after successful revision surgery and complete rehabilitation. However, the timeline is usually longer than after first-time surgery, often 12-18 months or more. High-level sports involving cutting and pivoting movements may be more difficult to resume at the same competitive level.
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Mt Elizabeth Novena
- 38 Irrawaddy Road #06-59/60/61 Mt Elizabeth Novena Specialist Centre Singapore 329563
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
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other practice locations
Farrer Park Hospital
- 1 Farrer Park Station Road #14-06 Connexion Singapore 217562
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
Mt Alvernia Medical Centre
- 820 Thomson Road #07-53 Mt Alvernia Medical Centre D Singapore 574623
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."
Billing & Payment
Consultation fees are charged based on length of consultation, and start from SGD$200 (within 30 minutes).
Modes of Payment
We accept the following modes of payment:
- Cash
- PayNow & PayLah
- All major Credit Cards
If you are insured and would like to use a Letter of Guarantee (LOG) from the major insurers in Singapore, please contact us and our friendly clinic staff will assist you and provide more information if required.
Can I Claim Through My Medisave Account? (For Singaporeans and PR)
Yes, you can. Our Clinic is an accredited day surgery clinic by the Ministry of Health. Singaporeans and Permanent Residents may use their Medisave for eligible orthopaedic inpatient procedures and hospitalizations.
The exact amount would depend on the complexity of the procedure. If you have any enquiries, feel free to speak to our friendly clinic staff about using your Medisave account.
Integrated Shield Plans (Singaporeans and PRs)
Yes, patients who have purchased Integrated Shield plans with riders for co-insurance and deductibles will be able to use them in our clinic for eligible procedures. For more information, contact us to find out if your procedure is claimable.
The 5 Approved Integrated Shield Insurers are:
- NTUC Income’s IncomeShield and Enhanced IncomeShield
- American International Assurance International Co’s (AIA) HealthShield Gold
- Great Eastern Life Assurance Co’s SupremeHealth and SupremeHealth Plus
- Prudential Assurance Co’s PRUShield
- AXA Shield