Total Knee Replacement, partial knee replacement MJRC India

ACL Injury (anterior cruciate ligament injury)

Anatomical background-
The ACL (anterior cruciate ligament) is one of four ligaments stabilising the knee joint. Ligaments are cord like tissues, which connect one bone to another. In the knee joint there are four ligaments, namely the medial collateral (inner), lateral collateral (outer), the anterior cruciate and the posterior cruciate. The anterior cruciate ligament runs from the back of the thigh-bone to the front of the inner side of the shin or leg bone. It prevents the leg bone from sliding off in front from the thigh bone. The ACL injury can be a partial sprain or a complete tear

Mechanism of injury-
The most common mechanism is a sports injury where there is a cutting or twisting injury to the knee.

Activities for risk
Injuries in sports like football when the player tries to tackle from the back, his knee twists and he falls to the ground. Involvements in other sports like basketball, cricket, skiing and hockey can also result in ACL injury. A blow to the knee from the front. A sudden decelerating injury during running. The commonest mode of injury in Chennai and other cities of India are scooter/ motor cycle accidents where the scooterist brakes suddenly, and plants his leg to the ground to balance himself. Patients with cruciate ligament injuries are prone to develop tears of the menisci(semilunar cartilages) and this can lead to secondary osteoarthritis


Symptoms
The person falls to the ground and is unable to continue the sport or activity which he was pursuing. He can feel or hear a popping sound in the knee joint. A swelling develops rapidly. There is a feeling of instability in the knee joint. Pain in the knee immediately, which worsens with the onset of swelling. Repeated giving away of the knee can occur as the patient runs around curves or while coming downstairs

What is the future for a patient with an ACL injury?
Complete ACL injuries result in instability of the knee joint. Whenever the person runs or comes downstairs rapidly the tibia slides off the femur. This can lead to repeated falls. These can result in injuries to the semilunar cartilages or menisci. Meniscal tears can lead to mechanical symptoms like locking or unexpected falls. A combination of persistent ligamentous laxity and meniscal tears can result in the development of secondary osteo-arthritis.

Treatment- RICE
(rest, ice, compression, elevation). An ACL injury is a serious one which needs medical attention immediately. The surgeon may aspirate the blood inside the joint to provide comfort. He may order a MRI scan to confirm the diagnosis immediately. An ACL injury can be treated conservatively in those individuals who are willing to restrict their sporting activity. 

ACL reconstruction
For those unwilling to do so, surgical treatment is advisable. Surgical treatment consists of an examination under anaesthesia, arthroscopy and ACL reconstruction.The orthopedic surgeon may decide to take a graft from the patellar tendon or hamstrings. Bony tunnels are drilled through the tibia and femur and the graft is fixed. I prefer a bone patellar tendon graft fixed with interference screws. I can also use hamstring tendon graft fixed in an anatomic manner with endo button and bio absorbable screw. See ACL reconstruction patient testimonial here- http://www.youtube.com/watch?v=ueVRMvpbVFU