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.
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.
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.
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.
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
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.
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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Consultant Orthopedic Surgeon,
Srikara Hospitals,#222 & 223,
Mythri Nagar, Phase-II,
Madinaguda, Miyapur, Hyderabad- 500 049.
Srikara Hospitals,#222 & 223,
Mythri Nagar, Phase-II,
Madinaguda, Miyapur, Hyderabad- 500 049.
Thanks for sharing valuable Information.
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