ACL Injury Clinic in India
ACL injuries are common. The common mechanisms of injuries include
- Sports injuries like foot ball, hockey, basketball,kabbadi etc
- Motor bike accidents
- Sea wave injuries
Approximately 50% of the ACL injuries occur in association with cartlage or meniscus injury or bony bruises.
Symptoms
When you injure your anterior cruciate ligament, you might hear a \\\"popping\\\" noise and you may feel your knee give out from under you. Other typical symptoms include:
- Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
- Loss of full range of motion
- Tenderness along the joint line
- Discomfort while walking
Physical Examination and Patient History
During your first visit, your doctor will talk to you about your symptoms and medical history.
During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
X-rays
Although they will not show any injury to your anterior cruciate ligament, X-rays can show whether the injury is associated with a broken bone.
MRI
This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.
Treatment
Treatment for an ACL tear will vary depending upon the patient\\\'s individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, I may recommend simple, nonsurgical options.
Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Surgical Treatment
Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. I will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.
There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.
Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.
Procedure. Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.
Unless ACL reconstruction is treatment for a combined ligament injury, it is usually not done right away. This delay gives the inflammation a chance to resolve, and allows a return of motion before surgery. Performing an ACL reconstruction too early greatly increases the risk of arthrofibrosis, or scar forming in the joint, which would risk a loss of knee motion.
Rehabilitation
Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.
If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete\\\'s.
MRI is the diagnosis of choice which shows the ligament injury, the meniscus injury, and the bony bruises.
Arthroscopic ACL RECONSTRUCTION
The ACL has to be reconstructed as it can not be stitched back that means a new implant has to be put. The choices of this graft include:
- Patellar tendon autograft (autograft comes from the patient)
- Hamstring tendon autograft
- Quadriceps tendon autograft
- Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon
Hamstring tendon graft
This is the gold standard graft as per my opinion. In this technique the semi tendinosus tendon and if needed gracilis tendon also is harvested through a micro incision, and a quadruple strand is created. The advantages of this graft include:
No donor site morbidity. The patellar tendon graft or the achillies tendon graft do have some donor site morbidity.
We do ACL reconstruction routinely. We use both the double bundle as well as the single bundle reconstruction using the hamstrig tendon graft. The tendons can be fixed using an endo button or interference screws.
Acl operation package- ACL operation packages range from nearly thirty thousand to fifty thousand rupees depending on the implants .
Rehabilitation after ACL RECONSTRUCTION.
Immediately after the surgery we start, static quadriceps exercises and ankle pumps, two days after we start in bed knee bending exercises. The knee is kept in a rigid knee brace for first few days but its taken out at the time of exercise.
On the second or third day the patient is made to walk with two crutches with partial weight bearing.
Crutches are needed for three weeks after surgery and then discarded.
See the exercise section for details.
Jogging can be started six weeks after, and sports generally can be started after ten weeks.
MENISCUS INJURIES
Meniscus injuries can occur either in isolation or in conjunction with ligament injury.
Meniscus injuries are treated with arthroscopic meniscus repair or meniscus balancing. Whether the meniscus will be balanced or repaired, depends upon, the area of the injury. If the injury is in the outer aspect, the meniscus can be repaired because this area of the meniscus is vascular.
If the injury occurs in the central part, meniscectomy or meniscus balancing ,may be needed.
Post op rehab
Immediately after the surgery we start static quadriceps exercises. Knee bending exercises and straight leg raising exercises are started the day after.
If meniscus repair is done, we need to maintain non weight bearing for two to three weeks or else if meniscectomy is done, partial weight bearing walking with two crutches will be needed