OPDDr.L H Hiranandani Hospital, Powai
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The anterior cruciate ligament (ACL) is a tough band of tissue joining the thigh bone to the shin bone at the knee joint. It runs diagonally through the inside of the knee and gives the knee joint stability. It also helps control the back-and-forth movement of the lower leg.
About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered “sprains” and are graded on a severity scale.
Grade 1 Sprains
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains
A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tear.
Mechanism of injury
The anterior cruciate ligament can be injured in several ways:
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.
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
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.
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, your doctor may recommend simple, nonsurgical options.
Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
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.
Surgery- ACL Reconstruction
The ACL is reconstructed using a graft to replace the torn ligament. The idea is for the graft to biologically incorporate within the knee and restore stability to the injured limb. At SKS, we recommend use of the hamstring (HS) tendons for the majority of patients [Figure 2]. The hamstrings lie at the back of the thigh and connect to the inner side of the tibia below the knee. One or two tendons are removed to form a graft of adequate thickness. The HS ACL Reconstruction has the advantages of a faster post-operative recovery, better cosmesis and less post-operative pain with kneeling and squatting activities. We use special techniques (quadruple semitendinosus, 6-strand and 8-strand grafts) to optimise the diameter of the new ACL to maximise its strength.
Arthroscopic Anterior cruciate ligament reconstruction
Other graft options exist including patellar tendon bone grafts (PTB) [Figure 3], the quadriceps tendon (from the front of the thigh to the kneecap) and cadaveric grafts (allografts).
The All Inside ACL Reconstruction
Currently We perform all inside anatomic ACL reconstruction with hamstrings graft and double bundle ACL reconstruction . The Advantage of an all inside technique is the advantage of preserving the lateral tibial cortex bone and allows the usage of smaller lengths of grafts.
All Inside Arthroscopic Anterior cruciate ligament reconstruction
All inside ACL reconstruction is a technique which involves reconstruction the Anterior cruciate ligament without drilling the tibial bone from outside . The technique involves creation of a socket from inside the knee thought specialized devices.