The Anterior Cruciate Ligament (ACL) injury is the most common when it comes to the injury of the Anterior Cruciate Ligament (ACL) injuryknee.
Causes
This most happens among sportsmen and this has lead to the invention of very successful operating techniques. The anterior cruciate ligament or ACL are tough bands of tissue that connect the ends of bones together, located in the center of the knee and are stretched between the femur and the tibia. The main role of this ligament is to keep the tibia from advancing in relationship to the femurin position and rotation. A muscular compensation is only possible just to a certain limit. This instability by a ACL rupture can lead to consequence a risk of meniscuses and cartilage lesions.
Once ruptured it looses it’s mechanical qualities, even if the fragments are brought together and sutured. A natural tendon taken from the knee itself must be used and is known as ligamentoplasty.
Symptoms
Though the symptoms following an ACL tear vary, swelling of the knee joint and a feeling of insecurity and instability of the knee when trying to change direction on the knees. Coming to a quick stop and difficulty in walking down a slope are the common other indications. Though the pain from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable.
Diagnosis
Physical examination is the best way to diagnose a ruptured or deficient ACL. Though swelling is an indicator, aspirating or draining the fluid is another way to check. If blood is found when draining the knee, there is a greater chance of a torn ACL. A cartilage injury can also be indicative through this test.
Other methods that are used are the Lachman test, the pivot-shift test and the anterior drawer test. During these tests any excess motion or unexpected movement of the tibia relative to the femur is an indicator to ligament damage. An MRI is the most accurate way to diagnose a damaged or torn ACL.
Treatment
The first approach would be to reduce inflammation and pain. The patient is advised rest along with suitable pain medications. Crutches would be used till you can walk without a limp. Once the pain is reduced, physiotherapy would be advised. A custom made ACL brace may be suggested which may help keep the knee from giving way during moderate activity.
On the event of continued instability a surgery would be suggested.
Procedure
This procedure is done under spinal anesthesia.
Arthroscopic Method
A reconstruction of the ACL using a piece of tendon or ligament to replace the torn ACL is the most preferred and this surgery is done using minimally invasive techniques. An arthroscope is used to view the inside of the knee joint and do the repairs by the surgeon. Most patients are discharged the same day and in certain cases a stay of one or two days in the hospital is advised
Patellar Tendon Graft
One type of graft used to replace the torn ACL is the patellar tendon. This tendon connects the kneecap (patella) to the tibia. The surgeon removes a strip from the center of the ligament to use as a replacement for the torn ACL.
Hamstring Tendon Graft
A hamstring graft to is also used to reconstruct a torn ACL. This graft is taken from one of the hamstring tendons that attaches to the tibia just below the knee joint. The hamstring muscles run down the back of the thigh. Their tendons cross the knee joint and connect on each side of the tibia. The graft used in ACL reconstruction is taken from the hamstring tendon, called the semitendinosus. This tendon runs along the inside part of the thigh and knee. The gracilis tendon is also included as part of the hamstring graft in certain situations. When arranged into multiple strips, the hamstring graft has nearly the same strength as a patellar tendon graft.
Allograft Reconstruction
In some cases, an allograft (a tissue that comes from someone else) is used. The tissue is checked for any type of infection, sterilized and stored in a freezer. When needed, the tissue is ordered by the surgeon and used to replace the torn ACL. The allograft can be from the tibialis tendon, patellar tendon, hamstring tendon, or Achilles tendon (the tendon that connects the calf muscles to the heel).
Many surgeons use patellar tendon allograft tissue because the tendon comes with the original bone still attached on each end of the graft (from the patella and from the tibia). This makes it easier to fix the allograft in place.
The advantage of using an allograft is that the surgeon does not have to disturb or remove any of the normal tissue from your knee to use as a graft. The operation also usually takes less time because the graft does not need to be harvested from your knee.
ACL surgery is generally safe. Complications if any can arise from surgery or during recovery phase. These may include:
Typical hospitalization is for five days. A suitable splint along with crutches will be used while mobilizing the knee. Walking is recommended after the third day. Walking should be done with the help of crutches for about 3 weeks. The splint has to be kept for a minimum of 3 weeks, but it is recommended to keep it until the end of the sixth week, when the transplant has healed in the bone tunnels. Beyond the first six weeks, walking without crutches and splint is possible. Driving a car is normally possible after 6 to 8 weeks; however a physical examination by a doctor is definitely advised.
The other Orthopedic Procedures are:
Few Major Hospitals for Treatment of Anterior Cruciate Ligament are:
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