1. Ligament Reconstruction / ACL Injury
The ACL or the Anterior Cruciate ligament is one of the most commonly injured ligaments of the knee. This ligament gives stability to the knee during all pivoting activities and is the main stabilizer of the knee . The knee has 2 cruciate ligaments and the other one is the PCL or Posterior cruciate ligament.
Approximately half of ACL injuries occur along with damage to the meniscus, articular cartilage, or other ligaments.
Injured ligaments are considered sprains and are graded on a severity scale of grade 1-2-3 . Most grade 2 and 3 require surgical intervention.
NonSurgical Treatment
Progressive physical therapy and rehabilitation can restore the knee to a condition close to its pre-injury state and teach the patient how to prevent instability. The doctor may also recommend wearing a hinged knee brace for added support. However, many people who choose not to have surgery suffer an injury to another part of the knee due to instability in the joint. Surgical treatment is usually recommended for combined injuries (ACL tears that occur along with other injuries in the knee).
Nonsurgical management of isolated ACL tears is likely to be successful or may be recommended in patients:
- With partial tears and no instability symptoms
- With complete tears who don’t experience symptoms of knee instability during low-demand sports and are willing to give up high-demand sports
- Who do light manual work or live sedentary (inactive) lifestyles
Surgical Treatment
ACL tears cannot be repaired (except a very small subset of acute avulsions)using sutures (stitches) because repaired ACLs have generally been shown to fail over time. Therefore, the torn ACL is generally replaced by a substitute graft made of tendon, including:
- Patellar, hamstring, or quadriceps tendon autograft (autografts come from the patient)
- Patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon allograft (allografts come from a tissue donor)
Who Should Consider ACL Reconstruction Surgery?
- Active adult patients who are involved in sports or jobs that require pivoting, turning, or hard-cutting, or who perform heavy manual work are encouraged to consider surgical treatment.
- In young children or adolescents with ACL tears, as delaying treatment can lead to a higher rate of future meniscus or cartilage injuries.
- A patient with a torn ACL and significant functional instability.
- It is common to see ACL injuries combined with damage to the menisci, articular cartilage, collateral ligaments, joint capsule, or a combination of the above.
What to expect from ACL Reconstruction Surgery?
You need to discuss in detail the requirements that you expect from the procedure. Many cases have other associated injuries like meniscus tears which will delay the rehabilitation and the expected return to pre injury levels . As like any other surgery this procedure has its own set of complications and adverse effects which you need to discuss in detail with your doctor before proceeding . Your age , preinjury level of activity, the associated injuries and the other comorbidities will decide the procedure and the outcomes from the procedure
2. Meniscus Tears
Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear the meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
Anatomy
Two bones meet to form your knee joint: the femur and the tibia. The knee cap (patella) sits in front of the joint to provide some protection. Two C shaped pieces of fibrocartilage one on the inside called as “Medial meniscus and the one on the outside called as “Lateral meniscus” act as shock absorbers between your femur and tibia. The menisci help to transmit weight from one bone to another and play an important role in knee stability. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.
Symptoms
You might feel a pop associated with sudden onset of pain and swelling when you tear the meniscus. You may feel sudden locking of the knee with inability to do activities. Pain and swelling will increase in the next couple of days and the knee will gradually become more stiff and swollen. The most common symptoms of a meniscus tear are:
- Pain
- Stiffness and swelling
- Locking of your knee
- The sensation of your knee giving way
- Inability to carry out pain free range of motion of the knee
Treatment
The treatment of meniscal injuries will depend on a number of factors, including your age, symptoms ,the location of tear ,the type of tear ,activity level and the return to sports expected . The meniscus has 3 zones depending on the need for surgery The Red -Red ,the Red -White and the White -white In todays arthroscopy surgeons the threshold to repair meniscus has increased due to the understanding of role of meniscus in preventing changes of osteoarthritis and also due to availability of good quality implants. The need for trimming or “partial meniscectomy “ has reduced over the last decade and is reserved only for complex or irreparable tears
Surgical Treatment
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Procedure. Knee arthroscopy is one of the most commonly performed surgical procedures. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. This provides a clear view of the inside of the knee. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear.
- Partial meniscectomy: In this procedure, the damaged meniscus tissue is trimmed away. This procedure typically allows for immediate weight bearing, and full range of motion soon after surgery.
- Meniscus repair: Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully repaired depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is longer than for a meniscectomy.