#aclreconstructionsurgery

Arthroscopic ACL Reconstruction:

The widespread use of technology has brought in a gigantic transformation in the field of medical sciences and healthcare. Technology has even made it possible for doctors to treat their patients in a virtual environment. The many inceptions that took birth in the surgical field have supplemented to the benefits of the patients. One such origination that constituted to the knee related surgeries is the Arthroscopic Surgery. The knee arthroscopy is a minimally invasive surgical technique, that allows orthopedic surgeons to assess the injury (joint) and repair any injuries without needing to fully open the joint.

ACL Injury:

The anterior cruciate ligament (ACL) connects your shin bone (tibia) to your thigh bone (femur). The ACL is one of a pair of ligaments in the middle of the knee joint, responsible for providing stability. A tear of this ligament can cause your knee to give way during physical activity.  It is a very strong ligament but if it gets overstretched, the fibers start to tear and can even rupture completely with enough force. ACL injuries which are common among people who play sports, account for approximately 40% of all sporting injuries and can lead to long-term pain and instability. The incidence of ACL injury is higher in those people who participate in sports such as basketball, football, skiing, and soccer.

Three grades of ACL injury:

Grade 1:

This is when the ligament is overstretched and less than 10% of the fibers are torn.  This should heal naturally in a few weeks.

Grade 2:

More of the fibers are torn but the ligament is still intact. This may heal with a rehab programme or may require an arthroscopic ACL surgery.

Grade 3:

The last phase or the extreme stage where the ligament is completely ruptured i.e., torn in two. Usually requires arthroscopic knee surgery.  

Grafting as per Surgical Recommendations:

Patellar tendon autograft

:  

This is occasionally referred to by some surgeons as the "gold standard" for ACL reconstruction. It is often recommended for high-demand athletes and patients whose jobs do not require a significant amount of kneeling. In this process, the middle third of the patellar tendon of the patient, along with a bone plug from the shin and the kneecap is used in the patellar tendon autograft.

Hamstring tendon autograft:

In this grafting, the semitendinosus hamstring tendon on the inner side of the knee is used in creating the hamstring tendon autograft for ACL reconstruction. Some surgeons use an additional tendon, the gracilis, which is attached below the knee in the same area. This creates a two- or four-strand tendon graft.

Quadriceps tendon autograft:        

The quadriceps tendon autograft is often used for patients who have already failed ACL reconstruction. The middle third of the patient's quadriceps tendon and a bone plug from the upper end of the knee cap are used. This yields a larger graft for taller and heavier patients. Because there is a bone plug on one side only, the fixation is not as solid as for the patellar tendon graft. There is a high association with postoperative anterior knee pain and a low risk of patella fracture. Patients may find the incision is not cosmetically appealing.

Allografts:

Allografts are grafts taken from cadavers and are used for patients who have failed ACL reconstruction before and in surgery to repair or reconstruct more than one knee ligament These grafts are becoming increasingly popular and the advantages of using allograft tissue include the elimination of pain caused by obtaining the graft from the patient, decreased surgery time and smaller incisions. The patellar tendon allograft allows for strong bony fixation in the tibial and femoral bone tunnels with screws.

When Do You Need A Surgery?

Arthroscopic ACL surgery is recommended if the knee keeps giving way/buckling due to chronic instability.

The knee that gives way or feels unstable during daily activities

Knee pain

Inability to return to sports or other activities

When other ligaments are also injured

When your meniscus is torn

If the meniscus tears, there is less protection for the knee bones and increased risk of developing arthritis.

About Dr. Kirthi Paladugu:

Dr. Kirthi Paladugu is a Orthopedist, Joint Replacement Surgeon and Sports Medicine Surgeon in Miyapur, Hyderabad and has a very good experience in these fields. Dr. Kirthi Paladugu practices at Srikara Hospitals in Miyapur, Hyderabad. He completed MBBS from Jagadguru Jayadeva Murugarajendra Medical College (JJMMC) in 2009,MS – Orthopaedics from Raichur Institute of Medical Sciences in 2013 and Fellowship in Joint Replacement from Germany in 2014.

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Dr. KIRTHI PALADUGU

Consultant Orthopedic Surgeon,

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Mythri Nagar, Phase-II,

Can't believe it's been two weeks already since surgery.

I'm walking around with less pain than before but the knee is incredibly stiff. Takes half the morning to get comfortable. The hardest part has been to keep myself occupied and it's been a little difficult to stay upbeat.