ACL reconstruction is advised to patients with persistent knee instability despite physiotherapy trial of at least 6 weeks. In cases of road traffic accident patients with high energy trauma who develop ACL tear along with variable injury to other ligaments and bony contusions, we prefer to wait for approximately 10-12 weeks before offering ACL reconstruction surgery. This allows adequate time for healing of other structures, before ACL reconstruction is undertaken.
ACL reconstruction is commonly performed as Arthroscopy assisted procedure, with minimal scar. We routinely perform ACL reconstruction surgery using Endobutton technique with Double bundle Hamstring grafts harvested from Semitendinosus and Gracilis muscles.
In this surgery tendinous grafts are harvested from the back of knee, doubled over to increase the tensile strength, and then looped over an Endobutton. This graft –endobutton composite is tunnelled across the tibia and femur along the axis of original ACL ligament. The tibial end is usually secured with titanium or bio-absorbable screws.
After surgery, patients are allowed to walk with Knee brace and walker support from the next day. Knee bending is increased in a sequential manner with increments week by week. Supervised physiotherapy is required for an estimated 6 weeks. It is estimated that most patients are able to walk full weight bearing after approx. 6 weeks, and walk without support after an average of 10-12 weeks
Knee Cartilage defects or Osteochondral lesions may produce pain and stiffness of the joint. If un-treated such lesions may lead to development of full thickness cartilage loss, and eventual arthritis.
Arthroscopic Chondroplasty can be performed in such cases, to allow cartilage regrowth, and delay the development of full blown arthritis.
Arthroscopic Chondroplasty procedure involves Microfracture/ Abrasion chondroplasty/ Laser. This allows the growth of fibrocartilage and help to fill up the void created by cartilage loss.
In cases of large solitary Osteochondral defects, Mosaicplasty may also be performed.These procedures help in delaying Arthritis, and are very useful in younger patients with knee pain not responding to conservative trial and physiotherapy. The patients are usually admitted in hospital for 24-48 hours. Ambulation with walker/ stick support is started the next day of surgery.
Knee Collateral ligaments include the Medial Collateral Ligament, and the Lateral Collateral Ligament. Collateral ligaments provide angulatory stability against varus/ valgus (sideways) stress.
Injuries to collateral ligaments of the knee may commonly occur due to fall while running or in cases of road traffic accidents, such as fall from bike. Most collateral ligaments injuries are partial rupture of ligaments.
MRI of the knee joint is the best way to diagnose the extent of injury.
Most cases of Collateral ligament injuries around the knee can be satisfactorily managed with bracing and rest. However, in some cases with complete tear of ligament, surgical intervention may be indicated.
Knee Arthroscopy is a minimally invasive procedure for correction of internal derangement of the knee. This procedure is performed by making a small ‘5 mm’ size cut on both sides of the knee joint. These portals are used to insert an arthro-scope with camera, and another is used for instruments to perform the required procedure.
It is usually performed under spinal anaesthesia. Common procedures/ indications for knee arthroscopy include,
Loose body removal,
Para-meniscal cysts excision,
Arthroscopic ChondroplastyArthroscopic Laser Chondroplasty
The patient may start walking from the next day of surgery, and over 90 % of them resume office within a week. Active sport activities should be avoided for approximately 3 weeks.